Analyst, Configuration Information Management

JOB DESCRIPTION 

Responsible for timely intake and accurate interpretation of regulatory requirements related to benefit coverage, service reimbursement, and processing of a claim to support system solutions development and maintenance for claim payment. This role includes coordination with stakeholders and subject matter experts on partner teams and support of governance committees where applicable.

DUTIES AND RESPONSIBILITIES

• Develops and maintains requirement documents related to coverage, reimbursement and other applicable claim adjudication areas to ensure alignment to regulatory baseline requirements and any health plan developed requirements
• Monitors regulatory sources to ensure all updates to products and payment are in alignment with contractual baselines
• Communicates requirement interpretations and changes to health plans and various impacted corporate core functional areas for coverage and payment requirement interpretation alignment and approvals as well as solution traceability through regular meetings and other operational process best practices
• Provide support for claim and/or requirement interpretation inconsistencies and inquiries
• Self-organized reporting to ensure health plans and other leadership are aware of work efforts and impact for any prospective or retrospective requirement changes that can impact financials
• Maintains tickets and work tracking tools
• Maintains relationships with Health Plans and Corporate teams to ensure all end-to-end business requirements have been documented and interpretation are agreed on and clear for solutioning  

KNOWLEDGE, SKILLS AND ABILITIES

• Policy/government legislative review knowledge
• Strong interpersonal and (oral and written) communication skills and ability to communicate with those in all positions of the company
• Ability to concisely synthesize large and complex requirements
• Ability to organize and maintain regulatory data including real-time policy changes
• Self-motivated and able to take initiative, identify, communicate, and resolve potential problems
• Ability to work independently in a remote environment
• Ability to work with those in other time zones than your own
• Ability to maintain requirements for multiple States

Required Experience

• 2 years of experience in previous roles in a managed care organization, health insurance or directly adjacent field
• Strong analytical and problem-solving skills
• Robust knowledge of Office Product Suite including Word, Excel including pivot tables and VLOOKUP's, Outlook and Teams

Preferred Experience

• Minimum Bachelor's Degree or equivalent experience; preferred focus of study in public health, public policy related to insurance and managed care or business
• Previous success in a dynamic and autonomous work environment
• Project implementation experience
• Knowledge and experience with federal regulatory policy resources including CMS and the Affordable Care Act
• Familiarity with claim administration systems
• Familiarity or interest in adoption of AI work tools including Microsoft Copilot
  

To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board.

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

Pay Range: $49,430.25 - $107,098.87 / ANNUAL
*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.

About Us

Molina Healthcare is a nationwide fortune 500 organization with a mission to provide quality healthcare to people receiving government assistance. If you are seeking a meaningful opportunity in a team-oriented environment, come be a part of a highly engaged workforce dedicated to our mission. Bring your passion and talents and together we can make a difference in the lives of others. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.