Government Programs Consultant

Capital Blue Cross•Harrisburg, PA

About The Position

This position is responsible for supporting the overall success of the Government Programs (GP) Division; supporting the implementation of new products and benefit enhancements of existing products. Also responsible for planning, developing and improving operational workflows, leading implementation cycles, updating/tracking annual timelines, and providing oversight of operational support systems in support of GP performance goals, ensuring compliance accuracy, and ensures products meet requirements/expectations of external (regulators, providers, members, vendors) and internal customers. Primary responsibilities include development and oversight of implementation activities from CMS and state application and regulatory filings through product launch and the entire product life cycle, as well as ongoing management of the GP product portfolio. This function also includes resolution of operational issues associated with product and account set up, ensuring products are functioning properly within existing systems (FACETS, PBM, Sales systems, etc), implementing guidance changes, and coordinating internal process communications. This individual will work on project teams with individuals with diverse levels of knowledge from throughout the organization and will use creativity and initiative in providing solutions which meet or exceed project objectives. The position will partner with Sales, Marketing, Stars, Clinical, Pharmacy, Actuarial, Legal, Compliance, Operational Departments and other subject matters experts throughout the enterprise to ensure effective product offerings are identified, filed, and implemented to meet the division's strategic priorities including targeted membership growth, profitability, and Stars/member retention goals.

Requirements

Proven successful experience leading complex projects, preferably in Government Programs products.
Effective communication, both written and oral, skills and strong skills with common PC software applications (i.e. Microsoft Office) required.
Excellent analytical and organizational required. Previous experience with the development of project plans and timelines, ability to assess global and operational impacts and define requirements.
Ability to build successful collaborative business relationships and partner with large cross-functional teams on new product implementations and changes.
Excellent presentation skills required including presentation development, product training, process improvements, and developing policies & procedures.
Experience using effective problem solving and decision-making techniques to develop recommendations and present to management/stakeholders.
Position requires strong attention to detail and high level of accuracy.
Minimum 3-5 years' experience in health insurance organization managing benefits, pricing, and the operational systems that support them.
Prior experience in compliance, operations, or project management experience is preferred.
While performing the duties of the job, the employee is frequently required to sit, use hands and fingers, talk, hear, and see.
The employee must be able to work over 40 hours per week.
The employee must occasionally lift and/or move up to 5 pounds.

Nice To Haves

Knowledge and understanding of Medicare regulations preferred

Responsibilities

Incumbent will assist Medicare Product and Vendor Management in the oversight and ongoing monitoring of GP vendors. Vendors include Ancillary Services and supplemental benefits. Responsible for assessing current vendor reporting/monitoring and implement new/updated processes where necessary.
Incumbent will work with management to coordinate resources when issues are identified, and business requires support for resolution. This involves coordination with Compliance Department and the incident reporting processes.
Provides business areas support during both internal and external audits and State/CMS reporting. Coordinates with business areas and Compliance team to ensure deliverables are submitted timely and accurately.
Incumbent will play a key role in interpreting and understanding CMS guidance and implementing product changes/updates and communicating to internal and external stakeholders on these regulatory updates.
Lead and/or participate in large, complex projects and manage business plans to achieve key business objectives, ensure regulatory/corporate deadlines are met.
Manage cross-segment projects and initiatives that require problem solving, relationship building, influencing and analyzing, including collaborating/implementation of new vendor RFPs, contracts, and oversight.
Adapt departmental plans, timelines, and priorities to address business, regulatory, and operational challenges.