Senior Analyst, Business (Enrollment)

Molina Healthcare is a healthcare company focused on managed care services. This senior analyst role supports the Enrollment CoE by improving enrollment processes, developing and maintaining business requirements, and coordinating cross-functionally to ensure regulatory and operational alignment.

Responsibilities:

• Develops and maintains requirement documents related to coverage, reimbursement and other applicable system changes to ensure alignment with regulatory and health plan/product requirements
• Monitors regulatory sources to ensure all updates are aligned
• Navigates analytical problems and clearly defines and documents unique specifications
• Supports development and ongoing interpretation of review processes, committees and collaboration with key partner organizations
• Recognizes, identifies and documents changes to existing business processes and identifies new opportunities for process developments and improvements
• Provides status updates to health plan/product team partners, senior leadership and applicable stakeholders
• Communicates requirement interpretations and changes to health plans/product teams and various impacted functional areas for requirement interpretation alignment and approval and solution traceability; coordinates meetings and champions/deploys operational process best practices
• Where applicable, codifies the requirements for system configuration alignment and interpretation
• Provides support and/or requirement interpretation inconsistencies and complaints
• Assists with the development of requirement solution standards and best practices, and suggests improvement processes as applicable to consistently apply requirements across states and products
• Facilitates self-organized reporting to ensure health plans/product teams, leaders, and applicable stakeholders are aware of work efforts and impact for prospective or retrospective requirement changes that impact financials
• Conducts industry research and engagement to evaluate, provide insights, and develop/deploy best practices
• Coordinates with applicable teams for analysis, impact and implementation of changes that impact health plan/product
• Engages with operational leadership and health plan support functions to review compliance-based issues for benefit planning purposes
• Ensures end-to-end business requirements are documented, interpretation is agreed upon, and solutioning is clear for all applicable parties
• Develops and maintains relationships with health plan/product teams and corporate operations
• Provides training and support to new and existing team members

Requirements:

• At least 4 years of operations/analyst experience in a managed care organization, health insurance setting or related field, or equivalent combination of relevant education and experience
• Policy/government and legislative review knowledge
• Analytical and problem-solving skills
• Ability to concisely synthesize large and complex requirements
• Ability to organize and maintain regulatory data including real-time policy changes
• Self-motivated and ability to take initiative, identify, communicate, and resolve potential problems
• Experience creating reporting tools/providing project/process updates
• Familiarity with administration systems
• Ability to work in a project team setting and complete individually assigned tasks within established timelines to meet desired deployment deadlines
• Ability to work cross-functionally across a highly matrixed organization
• Effective verbal, written and interpersonal communication skills, and ability to engage with stakeholders of all organizational levels
• Microsoft Office suite and applicable software programs proficiency
• Project management/implementation experience
• Health care experience
• Knowledge and experience with federal regulatory policy resources including Centers for Medicare & Medicaid Services (CMS) and the Affordable Care Act (ACA)