Analyst, Compliance (Business Analyst)

Compliance Analyst

Provides analyst support for compliance activities. Seeks to ensure the organization adheres to regulatory requirements, industry standards, and Molina internal policies, and prevent and/or detect violation of applicable laws and regulations, and protect the business from liability, fraudulent or abusive practices.

The candidate should be comfortable, under the guidance of a supervisor in reviewing rules and regulations to determine service levels (i.e. deadlines, turnaround times, etc.) related to the health care industry. The candidate should also have some level of computer proficiency, have basic experience in handling data, and be experienced with Microsoft Excel. Any level of Salesforce, SQL Server, or Databricks experience is a plus.

Essential Job Duties

• Supports day-to-day operations/initiatives of the compliance function.
• Provides technical expertise for Molina interdepartmental regulatory and legislative interpretation inquiries.
• Facilitates health plan compliance-related required reporting.
• Interprets and analyzes Medicare, Medicaid and Medicare-Medicaid Plan (MMP) required reporting.
• Creates and maintains monthly and quarterly key performance indicator (KPI) reports.
• Supports the regulatory memorandum distribution process.
• Manages compliance incidents and related processes, including associated corrective action plans (CAPs).
• Responds to legislative inquiries/complaints (state/federal insurance regulators, congressional inquiries, etc.).
• Coordinates site visits for state/federal regulators.
• Leads large, complex compliance-related projects to achieve compliance objectives.
• Interprets and analyzes state and federal regulatory manuals, and supports revision process as needed.
• Interprets and analyzes federal and state rules and requirements for proposed and final rules.
• Coordinates comments relating to federal notices of proposed rulemaking.
• Manages Centers for Medicare and Medicaid Services (CMS) user access.

Job Requirements

• At least 2 years of compliance and/or audit-related experience, or equivalent combination of relevant education and experience.
• Knowledge of health care regulatory frameworks.
• Detail-oriented; skilled in documentation review.
• Data analysis skills, and ability to generate reports.
• Ability to work independently and set/manage priorities.
• Ability to collaborate in a cross-functional highly matrixed organization, and interact with internal/external stakeholders, including regulators.
• Effective verbal and written communication skills.
• Microsoft Office suite and applicable software program(s) proficiency.

Preferred Qualifications

• Certified in Healthcare Compliance (CHC).
• Experience with risk assessment methodologies.
• Knowledge of internal control frameworks.

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