Medicare Regulatory Analyst
About The Position
This position is responsible for receipt and coordination of CMS MA-PD and PDP escalated complaints; submission of member and marketing materials to CMS for HCSC’s Medicare Advantage and Prescription Drug Plans; applying CMS regulations pertaining to Medicare Advantage and Prescription Drug Plans to the review of member and marketing materials prior to submission to CMS; providing assistance and guidance regarding Medicare Advantage and Prescription Drug Plan regulations to HISC staff; working with other areas of the organization on the development, testing and implementation of organization, process and system changes to ensure the requirements of the Medicare Advantage and Prescription Drug program are met; and assisting MCO in coordination of the contract with CMS enterprise-wide.
Requirements
- Bachelor’s degree in business OR 2 years’ experience with health insurance
- 1 year of experience with health insurance benefits and/or operations
- Knowledge of Medicare advantage product
- Verbal and written communication skills
- Ability to present Medicare trends and findings in meetings with management
- Ability to organize multiple tasks and responsibilities
- Ability to analyze data reports
- Experience developing and running queries in a database
- PC proficiency to include Microsoft Word, Excel, PowerPoint, and Lotus Notes
Nice To Haves
- Knowledge of CMS Medicare Advantage software applications
- Medicare Advantage and Prescription Drug Plan coverage including Regulations and Guidelines
- Knowledge of health benefits
Responsibilities
- Receipt and coordination of CMS MA-PD and PDP escalated complaints
- Submission of member and marketing materials to CMS for HCSC’s Medicare Advantage and Prescription Drug Plans
- Applying CMS regulations pertaining to Medicare Advantage and Prescription Drug Plans to the review of member and marketing materials prior to submission to CMS
- Providing assistance and guidance regarding Medicare Advantage and Prescription Drug Plan regulations to HISC staff
- Working with other areas of the organization on the development, testing and implementation of organization, process and system changes to ensure the requirements of the Medicare Advantage and Prescription Drug program are met
- Assisting MCO in coordination of the contract with CMS enterprise-wide
Benefits
- health and wellness benefits
- 401(k) savings plan
- pension plan
- paid time off
- paid parental leave
- disability insurance
- supplemental life insurance
- employee assistance program
- paid holidays
- tuition reimbursement
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
