Analyst, Compliance - (Remote) Must have experience with Medicare Advantage and CMS regulatory requirements.

Role Overview

Analyst, Compliance supporting compliance activities to ensure adherence to regulatory requirements, industry standards, and internal Molina policies. The role focuses on preventing and/or detecting violations of applicable laws and regulations and protecting the business from liability and fraudulent or abusive practices.

Responsibilities

• Support day-to-day compliance operations and initiatives.
• Provide regulatory and legislative interpretation expertise for interdepartmental inquiries.
• Facilitate required compliance reporting for health plans.
• Interpret and analyze required reporting for Medicare, Medicaid, and Medicare-Medicaid Plan (MMP).
• Create and maintain monthly and quarterly KPI reports.
• Support the regulatory memorandum distribution process.
• Manage compliance incidents and corrective action plans (CAPs).
• Respond to legislative inquiries/complaints from state/federal insurance regulators and congressional inquiries.
• Coordinate site visits for state and federal regulators.
• Lead large, complex compliance-related projects to achieve compliance objectives.
• Interpret and analyze state and federal regulatory manuals and support revision processes.
• Interpret federal and state rules for proposed and final rules; coordinate comments for federal notices of proposed rulemaking.
• Manage Centers for Medicare and Medicaid Services (CMS) user access.

Requirements

• At least 2 years of compliance and/or audit-related experience (or equivalent education/experience).
• Knowledge of healthcare regulatory frameworks.
• Detail-oriented with strong documentation review skills.
• Data analysis skills and ability to generate reports.
• Ability to work independently, set and manage priorities.
• Ability to collaborate cross-functionally with internal and external stakeholders, including regulators.
• Strong verbal and written communication skills.
• Proficiency with Microsoft Office and applicable software.

Preferred Qualifications

• Certified in Healthcare Compliance (CHC).
• Experience with risk assessment methodologies.
• Knowledge of internal control frameworks.