Description review
Analyst, Business
Molina Healthcare · United States · back to the listing
HR standards
58/100
needs work
Title ↔ description
86/100
strong
Reads as
Business Analyst
100% confident
What this role officially is
ICT business analyst — ESCO, the EU occupation classification
ICT business analysts are in charge of analysing and designing an organisation's processes and systems, assessing the business model and its integration with technology. They also identify change needs, assess the impact of the change, capture and document requirements and then ensure that these requirements are delivered whilst supporting the business through the implementation process.
Also known as: ICT business analysts, business process specialist, IT business analyst
How others title the same work
Startups
- Business Operations Associate AtoB
- Mid Product Analyst (Identity & Orchestration) Authologic
- Strategic Projects Associate Corgi Insurance
What the listing never says
- 25 bullet points. Long requirement lists deter qualified candidates, who read them as hard gates. Scope clarity
- No section describes what the person would actually do. Scope clarity
- No pay range published. Candidates cannot tell whether applying is worth their time. Pay transparency
The listing, marked up
Nothing in the wording of this listing tripped a check. The scores above still judge how complete and coherent it is.
JOB DESCRIPTION
Job Summary
Responsible 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.
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 developed requirements.
• Monitors sources to ensure all updates are aligned.
• Leads coordinated development and ongoing management /interpretation review process, committee structure and timing with key partner organizations.
• Conducts analysis to identify root cause and assist with problem management as it relates to state 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.
• Provides support for requirement interpretation inconsistencies and complaints.
• 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.
• Engages with operations leadership and Plan Support functions to review compliance-based issues for benefit planning purposes.
KNOWLEDGE/SKILLS/ABILITIES
• Maintains relationships with Health Plans/Product Team and Corporate Operations to ensure all end-to-end business requirements have been documented and interpretation is agreed on and clear for solutioning.
• Ability to meet aggressive timelines and balance multiple lines of business, states, and requirement areas.
• Strong interpersonal and (oral and written) communication skills and ability to communicate with those in all positions of the company.
• Ability to concisely synthesize large and complex requirements.
• Ability to organize and maintain regulatory data including real-time policy changes.
• Self-motivated and ability to take initiative, identify, communicate, and resolve potential problems.
• Ability to work independently in a remote environment.
• Ability to work with those in other time zones than your own.
JOB QUALIFICATIONS
Required Qualifications
• At least 2 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.
• Robust knowledge of Office Product Suite including Word, Excel, Outlook and Teams.
• Previous success in a dynamic and autonomous work environment.
• Power BI
Preferred Qualifications
• Project implementation experience
• Knowledge and experience with federal regulatory policy resources including Centers for Medicare & Medicaid Services (CMS) and the Affordable Care Act (ACA).
• Medical Coding certification.
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.
Originally posted on Himalayas
Job Summary
Responsible 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.
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 developed requirements.
• Monitors sources to ensure all updates are aligned.
• Leads coordinated development and ongoing management /interpretation review process, committee structure and timing with key partner organizations.
• Conducts analysis to identify root cause and assist with problem management as it relates to state 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.
• Provides support for requirement interpretation inconsistencies and complaints.
• 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.
• Engages with operations leadership and Plan Support functions to review compliance-based issues for benefit planning purposes.
KNOWLEDGE/SKILLS/ABILITIES
• Maintains relationships with Health Plans/Product Team and Corporate Operations to ensure all end-to-end business requirements have been documented and interpretation is agreed on and clear for solutioning.
• Ability to meet aggressive timelines and balance multiple lines of business, states, and requirement areas.
• Strong interpersonal and (oral and written) communication skills and ability to communicate with those in all positions of the company.
• Ability to concisely synthesize large and complex requirements.
• Ability to organize and maintain regulatory data including real-time policy changes.
• Self-motivated and ability to take initiative, identify, communicate, and resolve potential problems.
• Ability to work independently in a remote environment.
• Ability to work with those in other time zones than your own.
JOB QUALIFICATIONS
Required Qualifications
• At least 2 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.
• Robust knowledge of Office Product Suite including Word, Excel, Outlook and Teams.
• Previous success in a dynamic and autonomous work environment.
• Power BI
Preferred Qualifications
• Project implementation experience
• Knowledge and experience with federal regulatory policy resources including Centers for Medicare & Medicaid Services (CMS) and the Affordable Care Act (ACA).
• Medical Coding certification.
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.
Originally posted on Himalayas