Medicare Operations Analyst
Our Mission: Provide the best value in health insurance and related health services to improve the quality of life for Arizonans.
Inspire health in Arizona as the trusted leader in delivering affordable, innovative healthcare solutions.
Our Benefits: Our benefits provide work-life balance and the flexibility you need to be your best. We offer comprehensive medical, dental, and vision coverage; a 401K savings plan; paid holidays and vacations; and much more!
The Medicare Operations Analyst is accountable for maintaining an ongoing assessment and interpretation of the CMS Bid, Product Development and Marketing requirements which pertain to both the Medicare Advantage and Prescription Drug programs. The Analyst assists in assuring the efficient and effective delivery of services by contracted vendors associated with Medicare required and supplemental benefits entered into each annual Bid submission. The Analyst will assist the Director of Medicare Operations in educating internal and external departments regarding CMS Benefit requirements; developing product strategies with Marketing personnel; assisting with implementation of effective marketing strategies; and submitting annual bids to CMS.
- Assist Director of Medicare Operations in developing presentations for Executive leadership regarding annual Bid Submission requirements and activities, as well as identifying Medicare product enhancements annually.
- Assist in filing annual CMS Bid to CMS, including work with Actuaries, providing appropriate documentation to Actuaries and working with Finance and other Senior Leaders reading development of Bid assumptions (Gain/Loss, Risk Adjustment, Administrative Cost projections, etc.)
- Liaison for maintaining professional relationships between the enterprise and its partners involved in the operations of a Medicare Advantage program
- Monitor, analyze and ensure operational performance of various vendors for both Medicare Advantage and Prescription Drug Program
- Operations include but are not limited to: Marketing, Enrollment, Member Communications, Billing, Medical Claims, Prescription Drug Claims, etc.
- Research, track and resolve escalated issues regarding CMS approved benefits and programs
- Editing and updating organizational policies related to Bid Submission process
- Collaborating with internal teams to complete business projects and programs involving cross-functional teams of subject matter experts
- Collaborating with business and operational units to ensure regulations and guidance are accurately reflected in current policies and procedures, and that member communications and marketing materials are accurate, timely and meet federal requirements
- Lead Health Choice departments in the development and submission of member materials
- Review member and marketing materials to ensure accuracy, timeliness and guidelines are met and assist in submitting materials to CMS via HPMS
- Work with vendors (print/advertising) and Marketing on creating the final print documents of member related documents for mailing
- Research, track and resolve complex issues involving several entities and programs.
- Other duties as assigned.
Education / Experience / Other Requirements
- Bachelor's degree in Business, Social/Behavioral Science, Analytics or Healthcare Management related field from an accredited college or university is preferred.
Years of Experience:
- (1-3) years health related experience with health insurance, pharmacy, managed care, or healthcare related organization.
- General knowledge of Medicaid and Medicare, including interpretation and application of CMS regulations and guidance
- (1-3) years of Managed Care experience required
- (1-3) years of analysis and/or research experience
- (1-3) years of proficient working knowledge of PC programs including experience with MS Office Suite
- (1-3) years Medicare bid filing experience
- At least two (2) years of experience in monitoring vendors for accuracy and ensuring performance
- Project management experience including the ability to simultaneously manage multiple projects/tasks
- Effective verbal and written communication skills, with the ability to adapt communication style to suit a variety of audiences
- General knowledge of health care operations
- Knowledge of HIPAA privacy regulation and rules
- Knowledge of Fraud, Waste and Abuse programs for Medicare
- Proficient analytical skills and methodologies