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Part-time, Project-Based Consultant: Medicare Operations

Job Summary:

Provides expertise and consulting services to Medicare Advantage clients on the daily activities of a multi-functional operations area. Functional areas requiring expert level experience include but not limited to: Medicare enrollment and eligibility, claims processing, and call center operations, appeals and grievances. Experience with operations in a SNP plan desired.

Essential Functions:

  • Subject matter expertise in an operational functions of Medicare Part C Advantage Plan
  • Ability to review, interpret and implement state and federal guidance
  • Develops call center, claims and or enrollment and billing systems by establishing technical specifications; developing customer interaction and voice response systems, and voice networks; designing user interfaces; developing and executing user acceptance test plans; planning and controlling implementations.
  • Expert familiarity with regulatory guidance and requirements related to Medicare plan operations
  • Utilize extensive Medicare operations and compliance experience to make recommendations for the client
  • Familiarity with CMS Program audits preferred.
  • Mentor and drive work product based on the project.
  • Adhere to established corporate policies and procedures
  • Perform other duties, as necessary, to meet corporate objectives
  • Travel as required

Qualifications:

  • 5 years progressive experience in operations with time spent in a call center, claims, billing and enrollment, operations environment.
  • Must have strong Microsoft Office Suite skills. Advanced skills in Word, Excel, Access and PowerPoint required
  • Experience with Medicare and/or Medicaid standards required
  • Advanced degree or certification in audit, pharmacy or compliance discipline 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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Part-time, Project-Based Consultant: Medicare Operations

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