Part-time, Project-Based Consultant: Medicare Operations
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.
- 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
- 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.