JOB DESCRIPTION Job Summary
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.
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. To all current Molina employees. If you are interested in applying for this position, please apply through the Internal Job Board.
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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
Pay Range: $40,851.44 - $88,511.46 / ANNUAL
*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.
