Analyst, Compliance - Remote must have Medicare Advantage exp
About the position 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.
Responsibilities
- 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.
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.
Nice-to-haves
- Certified in Healthcare Compliance (CHC).
- Experience with risk assessment methodologies.
- Knowledge of internal control frameworks.
Benefits
- competitive benefits and compensation package