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Consultant: Medicare Subject Matter Expert

Job Summary:

Responsible for providing subject matter expertise on Medicare to effectively support our clients, as well as, managing the day to day responsibilities of project management.

Essential Functions:

Medicare Subject Matter Expert:

  • Provide subject matter expertise in designated areas of expertise
  • Provide review, interpretation and implementation of state and federal guidance
  • Perform CMS mock audits areas of specialty
  • Perform operational remediation in areas of specialty
  • Mentor and drive work product based on the project scope of work
  • Develop, review for quality and coordinate all deliverables
  • Oversee and administer ongoing monitoring program(s) based on CMS guidance
  • Updates policies, procedures and project work plans as needed.
  • Adhere to established corporate policies and procedures
  • Perform other duties, as necessary, to meet corporate objectives
  • Travel as required
  • Assist BluePeak Operations in scheduling BluePeak resources to meet client demand and balance workload.
  • Coordinate and collaborate with Project/Audit standardization committee for implementing audit or project management changes and/or templates.

Qualifications:

  • Bachelor’s degree and a minimum of five (5) years government, health care, pharmacy benefit management, compliance or quality profession (equivalent combination of education and experience considered.): Required
  • Must have strong Microsoft Office Suite skills. Advanced skills in Word, Excel, Access and PowerPoint: Required
  • Experience with Medicare and/or Medicaid regulations and guidance: Required
  • Advanced degree or certification in audit, pharmacy or compliance discipline: Preferred
  • Prior project management training and/or experience: Preferred
  • Must have strong verbal and written communication skills.
  • Individual should be detail oriented with strong organization, prioritization and analytical skills with the ability to work independently.
  • Must work well under tight timelines and adapt quickly to change in a fast-paced, team-oriented, and high-growth environment.

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Consultant: Medicare Subject Matter Expert

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