Medicare Operations Analyst

Central California Alliance for Health•Remote, California, CA

2d•$77,000 - $95,000

About The Position

The Medicare Operations Analyst supports Medicare operations, sales, and enrollment functions through analysis and interpretation of Medicare and Medi-Cal data, while ensuring compliance with applicable state and federal regulations. The role conducts complex research and analysis in support of Medicare Operations activities and serves as a subject matter expert and liaison to internal and external stakeholders. The position reports to the Medicare Operations Director.

Requirements

Bachelor's degree in Business Administration, Health Care Administration, Public Health, or a related field.
At least five years of progressively responsible experience related to Medicare membership operations and/or enrollment eligibility.
Knowledge of CMS guidelines related to Medicare sales and enrollment.
Knowledge of Medicare Advantage enrollment processes and financial reconciliation.
Knowledge of the contents and interpretation of monthly membership reports.
Knowledge of research, analysis, and reporting methods.
Knowledge of data analysis tools, CRM/enrollment systems, and databases.
Ability to analyze complex data sets and present actionable insights.
Ability to identify issues, gather and analyze information and data, reach sound conclusions, and make recommendations for action.
Ability to interpret, explain, and apply applicable policies, laws, codes, regulations, and contracts.
Ability to organize work, manage multiple projects and priorities, adapt to changing priorities, and meet deadlines.
Ability to assist with developing and implementing projects, systems, programs, policies, and procedures.
Ability to develop and implement operational workflows.
Applicants must be currently authorized to work in the United States on a full-time, ongoing basis without current or future need for employer-supported or employer-provided sponsorship.

Nice To Haves

A master's degree may substitute for two years of the required experience.
An equivalent combination of education and experience may qualify.

Responsibilities

Support Medicare operations, sales, and enrollment functions through analysis and interpretation of Medicare and Medi-Cal data.
Ensure compliance with applicable state and federal regulations.
Conduct complex research and analysis in support of Medicare Operations activities.
Act as a subject matter expert and liaison to internal and external stakeholders.
Analyze complex data sets and present actionable insights.
Identify issues, gather and analyze information and data, reach logical and sound conclusions, and recommend action.
Interpret, explain, and apply applicable policies, laws, codes, regulations, and contracts.
Organize work, manage multiple projects, establish priorities, adjust to changing priorities, and meet deadlines.
Assist with developing and implementing projects, systems, programs, policies, and procedures.
Develop and implement operational workflows.