Medicaid Regulatory Analyst
Health Care Service Corporation
Medicare Regulatory Analyst
Health Care Service Corporation
full-time
Posted on:
Origin: • 🇺🇸 United States • Montana
Visit company websiteSalary
💰 $40,900 - $91,000 per year
Job Level
Junior
About the role
- 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, Outlook, Excel and PowerPoint.
- Knowledge of CMS Medicare Advantage software applications
- Prescription Drug coverage and PPO knowledge including Regulations and Guidelines.
- Knowledge of health benefits
- Ability to affectively adapt and respond in a complex, fast-paced, high-volume environment.
- Ability to maintain positive/productive relationships and recommend solutions, if appropriate
- Ability to exercise administrative judgment and assumes responsibility for decisions, consequences, and results.
- Basic understanding of managed care and its place in the health care industry.
