Implementation Analyst II (4229BR) Charleston, South Carolina

Job Summary

Working with minimal supervision in a matrix reporting structure, this position is assigned to strategic implementations and integrations to develop or modify highly complex requirements, plan and implement work products, develop test scenarios, review UAT testing results and transition knowledge to health plan resources.   Research current contracts, RFPs, state websites to include companion guides, fee tables, state regulations and state notifications.  Research federal website to include implementation guides.  Work with existing health plans and other corporate departments to evaluate, research and author business requirements to meet contractual requirements and federal regulations.  Interact with the corporate subject matter experts, project directors, health plan owners and project management for assigned functional area.  Work with management to ensure business needs are met with appropriate priority.  Responsible for reporting performance to directors and above. Accountable for assessing, developing and delivering work products that comply with contractual requirements.  This position also serves as a mentor and provides informal leadership to other analytical staff.
This position can be based in Charleston, SC, or remotely.
Essential Functions
• Perform research, contract analysis and appropriate gap analysis to ensure thoroughness of work products. Analyst must read and interpret complex legal document, including contracts, federal and state regulations and administrative code and translate into business requirements that directly impact medical care ratios and administrative expenses.
• Work directly with health plan CEO’s/Senior Management and/or Corporate subject matter experts to understand their business needs, strategies, priorities and key issues. Assimilate and document this information into complex business requirements. Liaison to IT to ensure technical solutions meet business needs.  Liaison to Configuration to ensure QNXT configuration meets business needs.  Establish effective customer relationship with assigned resources including but not limited to project director, project managers, health plan leadership, and corporate subject matter experts.  Work with project team to develop and enhance the business requirement.  Develop user acceptance testing processes and evaluate results to ensure compliance with contractual and regulatory requirements to meet medical loss ratio expectations.
• Provide analytical and problem solving expertise, including: definition and documentation, business workflow analysis, state specific requirements, definition and documentation.  Recognize, identify and document changes to existing business processes and identify new opportunities for process developments and improvements.  Collaborate with technical resources in IT and configuration to ensure technical design and solutions will achieve business requirements. Create test cases based upon business requirements and a thorough understanding of technical design.
• Research, develop, format and QA fee tables for load into QNXT.  Evaluate provider claim and contract test results for appropriate benefit configuration and fee schedule load.
• Mentor and train new staff as well as provide ongoing support, leadership and training to new or integrating health plans.  Support new projects within existing health plans and non-project specific responsibilities in addition to their assigned work products.
• Develop and maintain work plans and other deliverables for assigned areas utilizing approved templates and practices to ensure consistent content and format is maintained across department.  Present to your project team the status of assigned work to include: functional area accomplishments, performance measurements, project status, and status of key issues.


• Ability to work independently and remotely
• Excellent organizational and analytical skills
• Ability to Multi-task
• Excellent verbal and written communication skills
• Ability to abide by Molina’s policies
• Maintain regular attendance based on agreed-upon schedule
• Maintain confidentiality and comply with Health Insurance Portability and Accountability Act (HIPAA)
• Ability to establish and maintain positive and effective work relationships with coworkers, clients, members, providers and customers

Required Education: 

Bachelor’s degree preferably in Business Management, Healthcare or Computer Science. Will consider professional experience in lieu of degree.
Required Experience: 
Minimum of 10 years proven analytical experience, preferably three or more years in the healthcare industry.  Managed care experience preferred. Minimum of 5 years project manager or supervisory capacity is preferred. Minimum 4-6 years experience working with complex, often highly technical teams preferred.
Molina Healthcare offers competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.
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