Senior Operations Analyst, Medicare Advantage Enrollment And Billing

This is a remote role that can be done from most US states.

Mass General Brigham Health Plan is an exciting place to be within the healthcare industry. As a member of Mass General Brigham, we are on the forefront of transformation with one of the world's leading integrated healthcare systems. Together, we are providing our members with innovative solutions centered on their health needs to expand access to seamless and affordable care and coverage.

Our work centers on creating an exceptional member experience - a commitment that starts with our employees. Working with some of the most accomplished professionals in healthcare today, our employees have opportunities to learn and contribute expertise within a consciously inclusive environment where diversity is celebrated.

We are pleased to offer competitive salaries, and a benefits package with flexible work options, career growth opportunities, and much more.

Reporting to the Director of Medicare Enrollment and Billing, the Senior Operations Analyst will be the point person for enrollment, billing, and payment monitoring and reconciliation. This includes but is not limited to developing and reviewing existing Operations policies, working with Operations teams to identify current gaps in procedures, implementing regulatory metric tracking, completing responses to the Enrollment and Billing monthly compliance monitoring program, notifying Operations departments of CMS regulatory changes, and alerting leadership of cross-departmental impacts and policy and process change requirements. The ideal candidate will be comfortable working cross-departmentally with all levels of leadership as well as documenting and presenting Enrollment and Billing reports

Principal Duties and Responsibilities

• Execute internal auditing and quality monitoring for daily, monthly, and annual transactions related to beneficiary, enrollment/disenrollment, membership benefit status and premium payment reconciliation.

• Develop subject matter expertise of complex Medicare/Medicaid program eligibility, and train others as needed. This will include developing and managing a quality assurance program for, but not limited to: application and eligibility verification, extracting OEC applications, processing enrollments, PBP changes, cancellations and disenrollments.

• Identify the root causes of the Audit results and develop Corrective Action Plan (CAP) for and with Enrollment & Billing team, and others as needed, following the CMS audit procedure.

• Assist in the process to ensure all CMS mandated government and state regulations are consistently met through daily auditing process. Coordinate with Compliance to ensure compliant policies and procedures.

• Provide administrative Medicare Enrollment eligibility information support to Appeals & Grievance department.

• Participate/Present in CMS Auditing including of requested universes.

• Analyze CMS Benefit Enrollment and Maintenance Transactions/Error(s) Report, reconcile all member eligibility data and mitigate errors, rejections received on the daily/monthly reports.

• Provide Knowledge Resource - training or coaching staff in business operational procedures.

• Review workflows with Compliance and Business Analyst to create internal Auditing/Developing Enrollment Training, including Policies & Procedures (P&P)

• Process/Research the Enrollment eligibility portion of the Part D Reconciliation (FIR/PDE) Report

• Assist in the development, implementation, monitoring and management of the Medicare Prescription Payment Plan

• Establishes and maintains effective relationships with internal stakeholders and gains their trust and respect.

• Work closely with the IT department to develop and monitor CMS required reports.

• Implement dashboards to enable stakeholders to see critical metrics with ease.

• Acts as subject matter expert on Low Income Subsidy requirements across Operations including point of service, initial enrollment and annual redeeming processes.

• Acts as a subject matter expert on Late Enrollment Penalty Requirements across operations.

• Inform, engage, inspire, motivate, and actively listen to employees.

• Identify/create processes and align resources to accomplish key objectives; clearly convey and assign clear accountability for important objectives, deadlines, and expectations.

• Hold self and others accountable to meet commitments.

• Ensure diversity, equity, and inclusion are integrated as a guiding principle.

• Persist in accomplishing objectives to consistently achieve results despite any obstacles and setbacks that arise.

• Build strong relationships and infrastructures that designate Mass General Brigham Health Plan as a people-first organization.

• Other duties as assigned with or without accommodation.

Qualifications

• Bachelor's degree required or the equivalent combination of training and experience, plus 5 years of experience in Medicare Advantage Enrollment and Billing

• Experience working with all levels of leadership and implementing Operational processes.

Skill, Abilities Competencies

• Written and verbal communications

• Strong computer skills including Word, Excel, and PowerPoint

• Ability to multi-task, prioritize and work within a team setting.

• Accountable for delivering high quality work

• Demonstrate Mass General Brigham Health Plan's core brand principles of always listening, challenging conventions, and providing value.

• Bring fresh ideas forward by listening to and working with employees and the people we serve.

• Respect the talent and unique contributions of every individual and treat all people in a fair and equitable manner.

• Strong, demonstrated track record of an ability to execute on time, on budget, and on scope.

• Strong aptitude for technology-based solutions.

• Ability to inject energy, when and where it's needed.

• Current in healthcare trends.

• Demonstrated forward, visionary thinking; ability to see "what is" and envision "what could be."

• Ability to develop, introduce, defend, and gain support for a new ideas and approaches.

• Excellent leadership skills and leadership track record.

• Ability to translate and communicate complex topics in a variety of forums, tailoring communications to effectively fit and influence the targeted audience, strong executive presence, presentation, and communication skills. Strong verbal, active listening, and written communication skills required.

• Ability to view the long-range trends and cycles of the business and industry and see the "big picture."

• Ability to apply a variety of strategic frameworks to analyze problems and to guide and develop solutions.

• Ability to challenge the status quo and drive innovative thinking and the capability to successfully implement strategy.

• Excellent interpersonal skills, including the ability to influence others at all levels of an organization.

• Strong EQ; exercises self-awareness; monitors impact on others; is receptive to and seeks out feedback; uses self-discipline to adjust to feedback.

• Unquestionable integrity.