Job Description
Note: The job is a remote job and is open to candidates in USA. Molina Healthcare is a company focused on providing healthcare solutions, and they are seeking a Business Analyst to manage regulatory and functional requirements related to coverage and reimbursement. The role involves coordination with stakeholders, developing requirement documents, and ensuring compliance with health plan requirements. 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 Skills • 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 • Previous MSP experience (contingent workforce management and operational support) • Experience with Vendor Management System (VMS), Beeline • Experience with Statement of Work (SOW) & Vendor contracting • Strategic sourcing experience • Experience with Vendor performance management • Reporting & Dashboard experience (i.e., proficient in Excel & Power BI, experience developing and building Vendor performance scorecards, cost savings reporting) Benefits • Molina Healthcare offers a competitive benefits and compensation package. Company Overview • Molina Healthcare is a healthcare company that specializes in government-sponsored healthcare programs for families and individuals. It was founded in 1980, and is headquartered in Long Beach, California, USA, with a workforce of 10001+ employees. Its website is Company H1B Sponsorship • Molina Healthcare has a track record of offering H1B sponsorships, with 56 in 2025, 45 in 2024, 43 in 2023, 31 in 2022, 35 in 2021, 55 in 2020. Please note that this does not guarantee sponsorship for this specific role. Apply tot his job
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