About The Company
Molina Healthcare is a leading healthcare organization committed to providing high-quality health services and innovative solutions to diverse populations across the United States. With a strong focus on community health, Molina Healthcare strives to improve health outcomes through comprehensive care management, innovative health plans, and dedicated support for underserved communities. The company values integrity, compassion, and excellence, fostering a collaborative environment that encourages professional growth and continuous improvement. Molina Healthcare's extensive network of healthcare providers and its commitment to regulatory compliance position it as a trusted partner in the healthcare industry, dedicated to making a positive impact on the lives of its members.
About The Role
The Regulatory Requirements Analyst plays a pivotal role in ensuring the accurate and timely intake, interpretation, and management of regulatory and functional requirements related to coverage, reimbursement, and processing functions. This position involves collaborating with stakeholders, subject matter experts, and cross-functional teams to develop and maintain comprehensive requirement documents aligned with regulatory standards and health plan policies. The analyst will lead coordination efforts for requirement development, review processes, and governance committees, ensuring compliance and clarity across all involved departments. Additionally, the role requires conducting root cause analysis, facilitating communication of requirement changes, and supporting resolution of interpretation inconsistencies. The analyst is also responsible for proactive reporting and engagement with operational leadership to review compliance issues, ultimately supporting the organization’s strategic and operational objectives.
Qualifications
At least 2 years of experience in a managed care organization, health insurance, or a related field, or an equivalent combination of education and experience.
Knowledge of policy review and government legislative processes.
Strong analytical and problem-solving skills.
Proficiency with Microsoft Office Suite, including Word, Excel, Outlook, and Teams.
Experience working in dynamic, autonomous environments with the ability to meet aggressive deadlines.
Responsibilities
Develop and maintain requirement documents related to coverage, reimbursement, and system changes to ensure alignment with regulatory baseline requirements and health plan policies.
Monitor sources for updates to ensure all changes are accurately reflected and aligned across systems.
Lead the development and management of review processes, committee structures, and stakeholder engagement to ensure timely and compliant requirement interpretation.
Conduct root cause analysis to identify issues and assist with problem resolution related to state-specific requirements.
Communicate requirement interpretations and updates to health plans, product teams, and other impacted departments for alignment and approval.
Support resolution of requirement interpretation inconsistencies and handle related complaints effectively.
Prepare and organize reports to keep leadership and product teams informed of ongoing work efforts and potential impacts on financials due to requirement changes.
Engage with operations leadership and Plan Support functions to review compliance issues and support benefit planning activities.
Benefits
Competitive salary and comprehensive benefits package.
Health, dental, and vision insurance options.
Retirement savings plans with company matching.
Paid time off and holiday leave.
Opportunities for professional development and career growth.
Supportive and inclusive work environment.
Equal Opportunity
Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V. We are committed to creating an inclusive environment for all employees and applicants, regardless of race, color, religion, gender, sexual orientation, gender identity or expression, age, national origin, disability, or veteran status. We encourage qualified individuals from all backgrounds to apply and join our team.

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