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Role Description

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. This role includes coordination with stakeholders and subject matter experts on partnering teams and supporting governance committees where applicable.

• Develops and maintains requirement documents related to coverage, reimbursement and other applicable system changes to ensure alignment to regulatory baseline requirements and any health plan/product team developed requirements.
• Monitors regulatory sources to ensure all updates are aligned and provides 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.
• Interprets customer business needs and translates 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.
• Codifies the requirements for system configuration alignment and interpretation where applicable.
• 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.
• 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.

Qualifications

• At least 4 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.
• Familiarity with administration systems.
• Robust knowledge of Office Product Suite including Word, Excel, Outlook and Teams.
• Previous success in a dynamic and autonomous work environment.

Requirements

• Project implementation experience (preferred).
• Knowledge and experience with federal regulatory policy resources including Centers for Medicare & Medicaid Services (CMS) and the Affordable Care Act (ACA) (preferred).
• Medical Coding certification (preferred).

Benefits

Molina Healthcare offers a competitive benefits and compensation package.

Company Description

Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.