Sr Business Analyst (Medical Claims Audit)

Job Description

JOB DESCRIPTION

Job Summary

Provides senior level support for accurate and timely intake and interpretation of regulatory and / or functional requirements related to but not limited to coverage, reimbursement, and processing functions to support systems solutions development and maintenance for Medical Claim Audit. This role includes coordination with stakeholders and subject matter experts on partnering teams and supporting governance committees where applicable.

JOB DUTIES

• 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 / product team developed requirements.
• Monitors regulatory sources to ensure all updates are aligned as well as work with operational leaders within the business to provide recommendations for process improvements and opportunities for cost savings.
• Leads coordinated development and ongoing management / interpretation review process, committee structure and timing with key partner organizations. Interpret customer business needs and translate them into application and operational 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.
• Where applicable, codifies the requirements for system configuration alignment and interpretation.
• Provides support for requirement interpretation inconsistencies and complaints.
• Assists with the development of requirement solution standards and best practices while suggesting improvement processes to consistently apply requirements across states and products where possible.
• 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.
• Coordinates with relevant teams for analysis, impact and implementation of changes that impact the product.
• Engages with operations leadership and Plan Support functions to review compliance-based issues for benefit planning purposes.

KNOWLEDGE / SKILLS / ABILITIES

JOB QUALIFICATIONS

Required Qualifications

Preferred Qualifications

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.