United States onlyJob Description
Job Summary
Under direct supervision of the Manager, the Reporting Analyst, SIU supports a team in the Special Investigation Unit (SIU). The Reporting Analyst, SIU will ensures FWA referrals are logged, documented, assigned for investigation and appropriately reported to state and federal regulators. and/or law enforcement as appropriate. Ensures that appropriate information is timely and accurately gathered and reported to state and federal regulators as appropriate (monthly, quarterly and annually). Provide oversight of designated SIU tracking systems. Duties may include: performing peer reviews to ensure Reporting and Triage activities are timely, accurate and in compliance with requirements prescribed by Molina Healthcare Inc., coordination with other departments to mitigate and remedy FWA.
JOB DUTIES (Main duties & responsibilities of the role):
- The position is responsible for creating regulatory reports specific to the SIU in support of contractual requirements, including reporting on overpayments identified and recovered; Tips/leads received; investigative case activity; any additional summary reports.
- Interprets and analyzes state and federal regulatory rules, contracts, and other guidance to assess compliance and support building regulatory compliance audit procedures
- 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
- 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
- Manage and produce their own inventory of regulatory reports.
- 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
- 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
- May develop and analyze trend reports to ensure contractual and regulatory compliance and performance improvement standards and for identification of any training needs;
- To avoid instances of non-compliance, the Reporting Analyst, SIU will ensure that MHI is meeting all regulatory reporting requirements for state and federal FWA notification.
- Will ensure compliance with all Molina Health Plans through report creation and execution.
- Serve as a backup to Sr Reporting Analyst.
- Perform peer reviews to ensure reporting activities are timely, accurate and in compliance with requirements prescribed by Molina Healthcare.
- Healthcare experience
- Excel-Proficient
- Healthcare Fraud Shield-preferred
Job Qualifications
REQUIRED EDUCATION:
Associate Degree or equivalent combination of education and experience
REQUIRED EXPERIENCE/KNOWLEDGE, SKILLS & ABILITIES:
Minimum 2 years experience in SIU, law enforcement, healthcare field or regulatory field
Minimum 1 years’ experience with regulatory reporting
PREFERRED EXPERIENCE:
• 2-4 experience working for a managed care organization
• 3-5 years experience in healthcare industry in related field desired (Regulatory, Compliance and Auditing)
PHYSICAL DEMANDS:
Working environment is generally favorable and lighting and temperature are adequate. Work is generally performed in an office environment in which there is only minimal exposure to unpleasant and/or hazardous working conditions. Must have the ability to sit for long periods. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential function.
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.
