Business Analyst jobs at HCA Healthcare

Provides lead level support for accurate and timely intake and interpretation of regulatory and/or functional requirements related but not limited to coverage, reimbursement, and processing functions to support systems solutions development and maintenance for system changes. This role includes coordination with stakeholders and subject matter experts on partnering teams and supporting governance committees where applicable. This role will work directly with Ohio Healthplan leadership including the Plan President, CFO, and other department heads to improve performance according to our Key Performance Indicators. Candidate will utilize SQL and Azure Databricks to query and analyze data however this is not just a technical role. They must be able to understand the business need, propose solutions, and meet KPIs. 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. Uses comprehensive background to navigate analytical problems, including: clearly defining and documenting their unique specifications. Leads coordinated development and ongoing management / interpretation review process, committee structure and timing with key partner organizations. * Recognizes, identifies and documents changes to existing business processes and identifies new opportunities for process developments and improvements. * Provides status and updates to health plan/product team partners, senior management and stakeholders. * 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 and/or 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. * Conducts industry research and engagement to evaluate, provide insights, and best practices as applicable. * 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. * Mentors and trains new staff as well as provide ongoing support, leadership, and training new/integrating health plans and corporate teams. 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. * Ability to lead complex projects across organizational boundaries with little direct instruction. * 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. * Create reporting tools to enhance communication on updates and initiatives. JOB QUALIFICATIONS Required Qualifications * At least 6 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. 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. Pay Range: $66,456 - $129,590 / ANNUAL * Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level. About Us Molina Healthcare is a nationwide fortune 500 organization with a mission to provide quality healthcare to people receiving government assistance. If you are seeking a meaningful opportunity in a team-oriented environment, come be a part of a highly engaged workforce dedicated to our mission. Bring your passion and talents and together we can make a difference in the lives of others. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.

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. **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. **Recoveries & Disputes** + Review and validate provider complaints and payment disputes, ensuring accurate and timely resolution in line with policy and contractual guidelines. + Partner with provider relations, Health plans and appeals teams to address recurring dispute trends and recommend systemic solutions. + Evaluate root cause for the disputes and recommend improvements to reduce claim errors and prevent improper payments. + Provide actionable insights and recommendations to leadership to drive continuous improvement. **Skills & Competencies** + Proven experience handling provider disputes, appeals, and overpayment recoveries in a managed care or payer environment. + In-depth knowledge of medical and hospital claims processing, including CPT/HCPCS, ICD, and modifier usage. + Strong understanding of claim system configurations, payment policies, and audit processes. + Exceptional analytical, problem-solving, and documentation skills. + Ability to translate complex business problems into clear system requirements and process improvements. + Proficiency in Excel + Knowledge in QNXT preferred + Strong communication and stakeholder management skills with ability to influence across teams. **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 are 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 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 **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. Pay Range: $77,969 - $128,519 / ANNUAL *Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.

Provides lead level support for accurate and timely intake and interpretation of regulatory and/or functional requirements related but not limited to coverage, reimbursement, and processing functions to support systems solutions development and maintenance for system changes. This role includes coordination with stakeholders and subject matter experts on partnering teams and supporting governance committees where applicable. This role will work directly with Ohio Healthplan leadership including the Plan President, CFO, and other department heads to improve performance according to our Key Performance Indicators. Candidate will utilize SQL and Azure Databricks to query and analyze data however this is not just a technical role. They must be able to understand the business need, propose solutions, and meet KPIs. **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. Uses comprehensive background to navigate analytical problems, including: clearly defining and documenting their unique specifications. Leads coordinated development and ongoing management / interpretation review process, committee structure and timing with key partner organizations. + Recognizes, identifies and documents changes to existing business processes and identifies new opportunities for process developments and improvements. + Provides status and updates to health plan/product team partners, senior management and stakeholders. + 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 and/or 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. + Conducts industry research and engagement to evaluate, provide insights, and best practices as applicable. + 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. + Mentors and trains new staff as well as provide ongoing support, leadership, and training new/integrating health plans and corporate teams. **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. + Ability to lead complex projects across organizational boundaries with little direct instruction. + 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. + Create reporting tools to enhance communication on updates and initiatives. **JOB QUALIFICATIONS** **Required Qualifications** + At least 6 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. **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. Pay Range: $66,456 - $129,590 / ANNUAL *Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.

Provides lead level support for accurate and timely intake and interpretation of regulatory and/or functional requirements related but not limited to coverage, reimbursement, and processing functions to support systems solutions development and maintenance for system changes. This role includes coordination with stakeholders and subject matter experts on partnering teams and supporting governance committees where applicable. This role will work directly with Ohio Healthplan leadership including the Plan President, CFO, and other department heads to improve performance according to our Key Performance Indicators. Candidate will utilize SQL and Azure Databricks to query and analyze data however this is not just a technical role. They must be able to understand the business need, propose solutions, and meet KPIs. 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. Uses comprehensive background to navigate analytical problems, including: clearly defining and documenting their unique specifications. Leads coordinated development and ongoing management / interpretation review process, committee structure and timing with key partner organizations. * Recognizes, identifies and documents changes to existing business processes and identifies new opportunities for process developments and improvements. * Provides status and updates to health plan/product team partners, senior management and stakeholders. * 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 and/or 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. * Conducts industry research and engagement to evaluate, provide insights, and best practices as applicable. * 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. * Mentors and trains new staff as well as provide ongoing support, leadership, and training new/integrating health plans and corporate teams. 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. * Ability to lead complex projects across organizational boundaries with little direct instruction. * 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. * Create reporting tools to enhance communication on updates and initiatives. JOB QUALIFICATIONS Required Qualifications * At least 6 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. 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. Pay Range: $66,456 - $129,590 / ANNUAL * Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level. About Us Molina Healthcare is a nationwide fortune 500 organization with a mission to provide quality healthcare to people receiving government assistance. If you are seeking a meaningful opportunity in a team-oriented environment, come be a part of a highly engaged workforce dedicated to our mission. Bring your passion and talents and together we can make a difference in the lives of others. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.

Provides lead level support for accurate and timely intake and interpretation of regulatory and/or functional requirements related but not limited to coverage, reimbursement, and processing functions to support systems solutions development and maintenance for system changes. This role includes coordination with stakeholders and subject matter experts on partnering teams and supporting governance committees where applicable. This role will work directly with Ohio Healthplan leadership including the Plan President, CFO, and other department heads to improve performance according to our Key Performance Indicators. Candidate will utilize SQL and Azure Databricks to query and analyze data however this is not just a technical role. They must be able to understand the business need, propose solutions, and meet KPIs. **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. Uses comprehensive background to navigate analytical problems, including: clearly defining and documenting their unique specifications. Leads coordinated development and ongoing management / interpretation review process, committee structure and timing with key partner organizations. + Recognizes, identifies and documents changes to existing business processes and identifies new opportunities for process developments and improvements. + Provides status and updates to health plan/product team partners, senior management and stakeholders. + 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 and/or 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. + Conducts industry research and engagement to evaluate, provide insights, and best practices as applicable. + 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. + Mentors and trains new staff as well as provide ongoing support, leadership, and training new/integrating health plans and corporate teams. **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. + Ability to lead complex projects across organizational boundaries with little direct instruction. + 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. + Create reporting tools to enhance communication on updates and initiatives. **JOB QUALIFICATIONS** **Required Qualifications** + At least 6 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. **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. Pay Range: $66,456 - $129,590 / ANNUAL *Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.

Provides lead level support for accurate and timely intake and interpretation of regulatory and/or functional requirements related but not limited to coverage, reimbursement, and processing functions to support systems solutions development and maintenance for system changes. This role includes coordination with stakeholders and subject matter experts on partnering teams and supporting governance committees where applicable. This role will work directly with Ohio Healthplan leadership including the Plan President, CFO, and other department heads to improve performance according to our Key Performance Indicators. Candidate will utilize SQL and Azure Databricks to query and analyze data however this is not just a technical role. They must be able to understand the business need, propose solutions, and meet KPIs. **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. Uses comprehensive background to navigate analytical problems, including: clearly defining and documenting their unique specifications. Leads coordinated development and ongoing management / interpretation review process, committee structure and timing with key partner organizations. + Recognizes, identifies and documents changes to existing business processes and identifies new opportunities for process developments and improvements. + Provides status and updates to health plan/product team partners, senior management and stakeholders. + 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 and/or 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. + Conducts industry research and engagement to evaluate, provide insights, and best practices as applicable. + 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. + Mentors and trains new staff as well as provide ongoing support, leadership, and training new/integrating health plans and corporate teams. **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. + Ability to lead complex projects across organizational boundaries with little direct instruction. + 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. + Create reporting tools to enhance communication on updates and initiatives. **JOB QUALIFICATIONS** **Required Qualifications** + At least 6 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. **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. Pay Range: $66,456 - $129,590 / ANNUAL *Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.

Provides lead level support for accurate and timely intake and interpretation of regulatory and/or functional requirements related but not limited to coverage, reimbursement, and processing functions to support systems solutions development and maintenance for system changes. This role includes coordination with stakeholders and subject matter experts on partnering teams and supporting governance committees where applicable. This role will work directly with Ohio Healthplan leadership including the Plan President, CFO, and other department heads to improve performance according to our Key Performance Indicators. Candidate will utilize SQL and Azure Databricks to query and analyze data however this is not just a technical role. They must be able to understand the business need, propose solutions, and meet KPIs. 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. Uses comprehensive background to navigate analytical problems, including: clearly defining and documenting their unique specifications. Leads coordinated development and ongoing management / interpretation review process, committee structure and timing with key partner organizations. * Recognizes, identifies and documents changes to existing business processes and identifies new opportunities for process developments and improvements. * Provides status and updates to health plan/product team partners, senior management and stakeholders. * 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 and/or 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. * Conducts industry research and engagement to evaluate, provide insights, and best practices as applicable. * 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. * Mentors and trains new staff as well as provide ongoing support, leadership, and training new/integrating health plans and corporate teams. 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. * Ability to lead complex projects across organizational boundaries with little direct instruction. * 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. * Create reporting tools to enhance communication on updates and initiatives. JOB QUALIFICATIONS Required Qualifications * At least 6 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. 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. Pay Range: $66,456 - $129,590 / ANNUAL * Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level. About Us Molina Healthcare is a nationwide fortune 500 organization with a mission to provide quality healthcare to people receiving government assistance. If you are seeking a meaningful opportunity in a team-oriented environment, come be a part of a highly engaged workforce dedicated to our mission. Bring your passion and talents and together we can make a difference in the lives of others. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.

Provides lead level support for accurate and timely intake and interpretation of regulatory and/or functional requirements related but not limited to coverage, reimbursement, and processing functions to support systems solutions development and maintenance for system changes. This role includes coordination with stakeholders and subject matter experts on partnering teams and supporting governance committees where applicable. This role will work directly with Ohio Healthplan leadership including the Plan President, CFO, and other department heads to improve performance according to our Key Performance Indicators. Candidate will utilize SQL and Azure Databricks to query and analyze data however this is not just a technical role. They must be able to understand the business need, propose solutions, and meet KPIs. 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. Uses comprehensive background to navigate analytical problems, including: clearly defining and documenting their unique specifications. Leads coordinated development and ongoing management / interpretation review process, committee structure and timing with key partner organizations. * Recognizes, identifies and documents changes to existing business processes and identifies new opportunities for process developments and improvements. * Provides status and updates to health plan/product team partners, senior management and stakeholders. * 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 and/or 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. * Conducts industry research and engagement to evaluate, provide insights, and best practices as applicable. * 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. * Mentors and trains new staff as well as provide ongoing support, leadership, and training new/integrating health plans and corporate teams. 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. * Ability to lead complex projects across organizational boundaries with little direct instruction. * 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. * Create reporting tools to enhance communication on updates and initiatives. JOB QUALIFICATIONS Required Qualifications * At least 6 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. 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. Pay Range: $66,456 - $129,590 / ANNUAL * Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level. About Us Molina Healthcare is a nationwide fortune 500 organization with a mission to provide quality healthcare to people receiving government assistance. If you are seeking a meaningful opportunity in a team-oriented environment, come be a part of a highly engaged workforce dedicated to our mission. Bring your passion and talents and together we can make a difference in the lives of others. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.

Provides lead level support for accurate and timely intake and interpretation of regulatory and/or functional requirements related but not limited to coverage, reimbursement, and processing functions to support systems solutions development and maintenance for system changes. This role includes coordination with stakeholders and subject matter experts on partnering teams and supporting governance committees where applicable. This role will work directly with Ohio Healthplan leadership including the Plan President, CFO, and other department heads to improve performance according to our Key Performance Indicators. Candidate will utilize SQL and Azure Databricks to query and analyze data however this is not just a technical role. They must be able to understand the business need, propose solutions, and meet KPIs. **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. Uses comprehensive background to navigate analytical problems, including: clearly defining and documenting their unique specifications. Leads coordinated development and ongoing management / interpretation review process, committee structure and timing with key partner organizations. + Recognizes, identifies and documents changes to existing business processes and identifies new opportunities for process developments and improvements. + Provides status and updates to health plan/product team partners, senior management and stakeholders. + 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 and/or 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. + Conducts industry research and engagement to evaluate, provide insights, and best practices as applicable. + 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. + Mentors and trains new staff as well as provide ongoing support, leadership, and training new/integrating health plans and corporate teams. **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. + Ability to lead complex projects across organizational boundaries with little direct instruction. + 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. + Create reporting tools to enhance communication on updates and initiatives. **JOB QUALIFICATIONS** **Required Qualifications** + At least 6 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. **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. Pay Range: $66,456 - $129,590 / ANNUAL *Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.

Provides lead level support for accurate and timely intake and interpretation of regulatory and/or functional requirements related but not limited to coverage, reimbursement, and processing functions to support systems solutions development and maintenance for system changes. This role includes coordination with stakeholders and subject matter experts on partnering teams and supporting governance committees where applicable. This role will work directly with Ohio Healthplan leadership including the Plan President, CFO, and other department heads to improve performance according to our Key Performance Indicators. Candidate will utilize SQL and Azure Databricks to query and analyze data however this is not just a technical role. They must be able to understand the business need, propose solutions, and meet KPIs. 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. Uses comprehensive background to navigate analytical problems, including: clearly defining and documenting their unique specifications. Leads coordinated development and ongoing management / interpretation review process, committee structure and timing with key partner organizations. * Recognizes, identifies and documents changes to existing business processes and identifies new opportunities for process developments and improvements. * Provides status and updates to health plan/product team partners, senior management and stakeholders. * 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 and/or 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. * Conducts industry research and engagement to evaluate, provide insights, and best practices as applicable. * 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. * Mentors and trains new staff as well as provide ongoing support, leadership, and training new/integrating health plans and corporate teams. 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. * Ability to lead complex projects across organizational boundaries with little direct instruction. * 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. * Create reporting tools to enhance communication on updates and initiatives. JOB QUALIFICATIONS Required Qualifications * At least 6 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. 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. Pay Range: $66,456 - $129,590 / ANNUAL * Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level. About Us Molina Healthcare is a nationwide fortune 500 organization with a mission to provide quality healthcare to people receiving government assistance. If you are seeking a meaningful opportunity in a team-oriented environment, come be a part of a highly engaged workforce dedicated to our mission. Bring your passion and talents and together we can make a difference in the lives of others. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.

CHSPSC, LLC seeks an IT Imaging Support & Process Analyst to assist with leading escalated support activities and provide process improvement initiatives. The role will be involved with the facilitation of application services management processes pertaining to analyzing value, evaluating risk, prioritizing projects and onboarding new technology requests to ensure alignment with organizational strategies for the imaging service line. Key responsibilities include: Alignment with the imaging team to address escalated support issues Review transition materials from the Project Management Office for application product ownership Develop and maintain application support plans Document current state and contribute to the direction of the application lifecycle management (LCM) roadmap to reduce costs, mitigate risks, and drive growth and revenue Participate in imaging related efforts such as Disaster Recovery exercises, Cyber Table Top exercises, etc. Present to executive leadership on support-related issues Understand current processes and propose more efficient methods Strategic analysis of the enterprise application portfolio including lifecycle management, application rationalization, consolidation and standardization to achieve the department objectives of the organization including reducing variation of redundant or unused applications Understand the definition, implementation and support of portfolio management standards, policies and processes Understand the data driven decisions pertaining to IT project investments Participate in the structure, attributes, taxonomies and nomenclature of service line elements and categories within the repository toolset (ServiceNow) to ensure completeness and accuracy of the list of enterprise IT business applications Collaborate with business partners, technology leaders and department directors to identify and promote adoption of enterprise standards and rationalization of application systems to achieve economic and patient experience improvement goals Provide expertise on decisions and priorities regarding the overall enterprise application portfolio Track application and vendor trends and maintain knowledge of new technologies to support the organization's current and future needs Maintain an awareness of industry standard best practices and apply relevant methodologies for process improvement Participate in application rationalization feasibility analysis and proposals for management and business partners which support the organization's clinical and economic objectives Review and support applications' advantages, risks, costs, benefits and impact on the enterprise business process and goals Develop and maintain productive relationships of trust both within and outside CHS and embrace the authoritative role in respect to maintaining enterprise standards and align others to the strategic direction Collaborate with Audit teams to respond to and mitigate audit findings and manage audit controls related to application systems and LCM Educate peers and business partners on department methodologies and drive adoption of standard process Support and evaluate portfolio risks and recommend mitigation plans Support business impact analysis and application criticality assessments Partner with key business and delivery stakeholders to conduct application and service line reviews including scope, metrics, expenses and net promoter scores to determine the disposition of existing and proposed solutions Communicate timely and accurate status to appropriate levels and stakeholders including the development and delivery of status reports and presentations Required: Results oriented mentality to drive accurate deliverables with appropriate time to market while taking responsibility for the outcomes Customer focused to align services with customer needs Creativity in developing and executing innovative strategies to meet unique customer needs Excellent verbal and written communication, presentation and customer service skills Ability to handle pressure to meet business requirement demands and deadlines Expertise in analyzing and presenting large volumes of data to senior leadership Critical thinking in developing proposals with sound analysis and achievable outcomes Ability to prioritize tasks and quickly adjust in a rapidly changing environment Exceptional analytic problem solving skills Ability to work independently and in a team environment Organizational awareness and the ability to understand relationships to get things accomplished more effectively Preferred: Experience with APM, CMDB and CSDM components within the ServiceNow platform Application product ownership experience Strong relationship management experience Project management experience/certification 4 or more years in an application portfolio/services management role Lean / Six Sigma Green Belt ITIL certifications Qualifications and Education Requirements: Bachelor's degree in Clinical Informatics, Health Science, Information Systems, Computer Science or a related discipline, or 2 years of relevant experience

Provides lead level support for accurate and timely intake and interpretation of regulatory and/or functional requirements related but not limited to coverage, reimbursement, and processing functions to support systems solutions development and maintenance for system changes. This role includes coordination with stakeholders and subject matter experts on partnering teams and supporting governance committees where applicable. This role will work directly with Ohio Healthplan leadership including the Plan President, CFO, and other department heads to improve performance according to our Key Performance Indicators. Candidate will utilize SQL and Azure Databricks to query and analyze data however this is not just a technical role. They must be able to understand the business need, propose solutions, and meet KPIs. **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. Uses comprehensive background to navigate analytical problems, including: clearly defining and documenting their unique specifications. Leads coordinated development and ongoing management / interpretation review process, committee structure and timing with key partner organizations. + Recognizes, identifies and documents changes to existing business processes and identifies new opportunities for process developments and improvements. + Provides status and updates to health plan/product team partners, senior management and stakeholders. + 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 and/or 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. + Conducts industry research and engagement to evaluate, provide insights, and best practices as applicable. + 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. + Mentors and trains new staff as well as provide ongoing support, leadership, and training new/integrating health plans and corporate teams. **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. + Ability to lead complex projects across organizational boundaries with little direct instruction. + 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. + Create reporting tools to enhance communication on updates and initiatives. **JOB QUALIFICATIONS** **Required Qualifications** + At least 6 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. **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. Pay Range: $66,456 - $129,590 / ANNUAL *Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.

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. **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** + Maintains relationships with Health Plans/Product Team and Corporate Operations to ensure all end-to-end business requirements have been documented and interpretation are 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 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 **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. Pay Range: $77,969 - $128,519 / ANNUAL *Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.

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. **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. **Recoveries & Disputes** + Review and validate provider complaints and payment disputes, ensuring accurate and timely resolution in line with policy and contractual guidelines. + Partner with provider relations, Health plans and appeals teams to address recurring dispute trends and recommend systemic solutions. + Evaluate root cause for the disputes and recommend improvements to reduce claim errors and prevent improper payments. + Provide actionable insights and recommendations to leadership to drive continuous improvement. **Skills & Competencies** + Proven experience handling provider disputes, appeals, and overpayment recoveries in a managed care or payer environment. + In-depth knowledge of medical and hospital claims processing, including CPT/HCPCS, ICD, and modifier usage. + Strong understanding of claim system configurations, payment policies, and audit processes. + Exceptional analytical, problem-solving, and documentation skills. + Ability to translate complex business problems into clear system requirements and process improvements. + Proficiency in Excel + Knowledge in QNXT preferred + Strong communication and stakeholder management skills with ability to influence across teams. **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 are 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 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 **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. Pay Range: $77,969 - $128,519 / ANNUAL *Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.

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. **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. **Recoveries & Disputes** + Review and validate provider complaints and payment disputes, ensuring accurate and timely resolution in line with policy and contractual guidelines. + Partner with provider relations, Health plans and appeals teams to address recurring dispute trends and recommend systemic solutions. + Evaluate root cause for the disputes and recommend improvements to reduce claim errors and prevent improper payments. + Provide actionable insights and recommendations to leadership to drive continuous improvement. **Skills & Competencies** + Proven experience handling provider disputes, appeals, and overpayment recoveries in a managed care or payer environment. + In-depth knowledge of medical and hospital claims processing, including CPT/HCPCS, ICD, and modifier usage. + Strong understanding of claim system configurations, payment policies, and audit processes. + Exceptional analytical, problem-solving, and documentation skills. + Ability to translate complex business problems into clear system requirements and process improvements. + Proficiency in Excel + Knowledge in QNXT preferred + Strong communication and stakeholder management skills with ability to influence across teams. **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 are 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 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 **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. Pay Range: $77,969 - $128,519 / ANNUAL *Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.

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. **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. **Recoveries & Disputes** + Review and validate provider complaints and payment disputes, ensuring accurate and timely resolution in line with policy and contractual guidelines. + Partner with provider relations, Health plans and appeals teams to address recurring dispute trends and recommend systemic solutions. + Evaluate root cause for the disputes and recommend improvements to reduce claim errors and prevent improper payments. + Provide actionable insights and recommendations to leadership to drive continuous improvement. **Skills & Competencies** + Proven experience handling provider disputes, appeals, and overpayment recoveries in a managed care or payer environment. + In-depth knowledge of medical and hospital claims processing, including CPT/HCPCS, ICD, and modifier usage. + Strong understanding of claim system configurations, payment policies, and audit processes. + Exceptional analytical, problem-solving, and documentation skills. + Ability to translate complex business problems into clear system requirements and process improvements. + Proficiency in Excel + Knowledge in QNXT preferred + Strong communication and stakeholder management skills with ability to influence across teams. **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 are 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 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 **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. Pay Range: $77,969 - $128,519 / ANNUAL *Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.

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. **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** + Maintains relationships with Health Plans/Product Team and Corporate Operations to ensure all end-to-end business requirements have been documented and interpretation are 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 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 **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. Pay Range: $77,969 - $128,519 / ANNUAL *Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.

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. **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. **Recoveries & Disputes** + Review and validate provider complaints and payment disputes, ensuring accurate and timely resolution in line with policy and contractual guidelines. + Partner with provider relations, Health plans and appeals teams to address recurring dispute trends and recommend systemic solutions. + Evaluate root cause for the disputes and recommend improvements to reduce claim errors and prevent improper payments. + Provide actionable insights and recommendations to leadership to drive continuous improvement. **Skills & Competencies** + Proven experience handling provider disputes, appeals, and overpayment recoveries in a managed care or payer environment. + In-depth knowledge of medical and hospital claims processing, including CPT/HCPCS, ICD, and modifier usage. + Strong understanding of claim system configurations, payment policies, and audit processes. + Exceptional analytical, problem-solving, and documentation skills. + Ability to translate complex business problems into clear system requirements and process improvements. + Proficiency in Excel + Knowledge in QNXT preferred + Strong communication and stakeholder management skills with ability to influence across teams. **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 are 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 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 **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. Pay Range: $77,969 - $128,519 / ANNUAL *Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.

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. **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. **Recoveries & Disputes** + Review and validate provider complaints and payment disputes, ensuring accurate and timely resolution in line with policy and contractual guidelines. + Partner with provider relations, Health plans and appeals teams to address recurring dispute trends and recommend systemic solutions. + Evaluate root cause for the disputes and recommend improvements to reduce claim errors and prevent improper payments. + Provide actionable insights and recommendations to leadership to drive continuous improvement. **Skills & Competencies** + Proven experience handling provider disputes, appeals, and overpayment recoveries in a managed care or payer environment. + In-depth knowledge of medical and hospital claims processing, including CPT/HCPCS, ICD, and modifier usage. + Strong understanding of claim system configurations, payment policies, and audit processes. + Exceptional analytical, problem-solving, and documentation skills. + Ability to translate complex business problems into clear system requirements and process improvements. + Proficiency in Excel + Knowledge in QNXT preferred + Strong communication and stakeholder management skills with ability to influence across teams. **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 are 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 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 **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. Pay Range: $77,969 - $128,519 / ANNUAL *Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.