Analyst, Siu (Remote) Jobs

Job Summary

The FWA Analyst, SIU works with health plans and operations departments to assess, oversee, and recommend business practices to ensure adherence to and compliance with State and Federal regulatory guidelines. The Analyst develops and performs audits and oversight functions involving business-critical operations and vendor outsourcing arrangements for the company. The Analyst also validates the appropriate oversight, reporting, and controls are in place for the operational functions of the organization and outsourced vendor work.

Knowledge/Skills/Abilities

• At the direction of management, performs oversight audits and validation activities to ensure operational regulatory compliance with Federal and State laws and regulations, contract provisions, and internal policies and procedures
• May develop and analyze trend reports to ensure contractual and regulatory compliance and performance improvement standards and for identification of any training needs; May create and maintain summary Key Performance Indicator (KPI) compliance reports for Corporate Operations
• May support health plans and MHI Business Owners with external regulatory audit requests including the completion of audit risk assessments, the preparation and submission of sample universes, and submission of SOPs, regulatory requests for information, training materials, and/or other evidence as part of regulatory audits. EX: DMHC, CMS active audits
• Recommends new or updated job aids/, work flows, reporting, controls, staffing needs, process, and/or technology changes based on audit results
• Based on regulatory and contractual requirements, and in collaboration with Business Owners, Corporate Compliance, and other key stakeholders, develops and communicates audit scope, objectives, and timelines
• Supports the Special Investigations Unit (SIU) Manager, Director, and team in the general development of the Operational Oversight Program including, but not limited to, creating regulatory reports, FWA complaint intake triage, assigning complaints to staff as directed by management, and demonstrate compliance to regulatory requirements across all Molina Healthcare Plans
• Ability to work independently or in a team, support multiple projects at once, and perform other duties or special projects as required.
• Demonstrates solid analytical and problem solving skills; self-starter
• Interprets and analyzes state and federal regulatory rules, contracts, and other guidance to assess compliance and support building regulatory compliance audit procedures

Job Qualifications

Required Education

High school diploma

Required Experience

Entry level

Preferred Experience

• One-year experience working for a Managed Care Organization
• 3-5 years experience in healthcare industry in related field desired (Regulatory, Compliance and Auditing)

To all current Molina employees: If you are interested in applying for this position, please apply through the intranet job listing.

Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.