Business Analyst, Provider Network (Salesforce Needed) Remote

Molina Healthcare is hiring a Business Analyst, Provider Network, to support healthcare and managed care operations. The role interprets regulatory and functional requirements related to coverage, reimbursement, and processing, coordinates with stakeholders and governance committees, and supports systems solutions, compliance, and requirement traceability.

Responsibilities:

• Develops and maintains requirement documents related to coverage, reimbursement and other applicable system changes in areas to ensure alignment to regulatory baseline requirements and any health plan developed requirements
• Monitors sources to ensure all updates are aligned
• Leads coordinated development and ongoing management /interpretation review process, committee structure and timing with key partner organizations
• Conducts analysis to identify root cause and assist with problem management as it relates to state requirements
• Communicates requirement interpretations and changes to health plans/product team and various impacted corporate core functional areas for requirement interpretation alignment and approvals as well as solution traceability through regular meetings and other operational process best practices
• Provides support for requirement interpretation inconsistencies and complaints
• Self-organized reporting to ensure health plans/product team and other leadership are aware of work efforts and impact for any prospective or retrospective requirement changes that can impact financials
• Engages with operations leadership and Plan Support functions to review compliance-based issues for benefit planning purposes

Requirements:

• • Managed Care / Healthcare experience in the Provider space
• • Business Operations experience
• • At least 2 years of experience in previous roles in a managed care organization, health insurance or directly adjacent field, or equivalent combination of relevant education and experience
• • Policy/government legislative review knowledge
• • Strong analytical and problem-solving skills
• • Robust knowledge of Office Product Suite including Word, Excel, Outlook and Teams
• • Previous success in a dynamic and autonomous work environment
• • Salesforce knowledge, a certification is helpful
• • Project implementation experience
• • Knowledge and experience with federal regulatory policy resources including Centers for Medicare & Medicaid Services (CMS) and the Affordable Care Act (ACA)
• • Medical Coding certification