Medicare Operations LeaderPrimary Location: Parsippany, New Jersey
Additional Locations: NJ-Parsippany Apply
59493Fundamental Components: Directs operational functions of Medicare products across a market. Responsible for the oversight and execution of all CMS required activities and processes including the accuracy and compliance of the annual bid application, expansion application, member materials, group set up. Facilitates internal and external Medicare audit activity including CMS and operation integrity audits. Coordinates file pulls, data requests, universe development and supporting documentation. Maintains awareness of trends, developments and governmental regulations in Medicare and managed health care organizations. Responsible for Medicare product design features, integration schedule and operational readiness for existing and new product start-ups. Participates in various committees to represent the Medicare Department including NCQA, Internal Research, UM, QI, Trend/MER, Risk Mitigation, Complaint and Appeals, bid, implementation, migration, etc. Leads member retention activities, including development of outreach material, design/implementation of outreach programs both directly and in coordination with corporate member retention team, development of talking points/educational pieces about market specific issues. Monitors sales and marketing activities to assure adherence to Federal and State regulations. Uses competitive intelligence to guide, consult and drive product implementation and strategic focus for Medicare Part D and Medicare Advantage. Coordinates strategies and recommends policy positions with senior management regarding legislative issues and regulatory with a key support function in program and project management in support of Medicare Advantage and Medicare Part D, including Stars, Revenue Management, Quality and Network concerns. Develops and implements business strategies to provide accurate and proactive customer service to members, plan sponsors and brokers. Provides operational support for market management of plan sponsors, members and network providers Background Experience: Ability to perform analysis and legal research to identify and clarify issues.
Familiarity with regulations and statutes impacting the Medicare business.
Business acumen and experience with managing complex processes.
Significant (7+) years’ experience in Medicare or equivalent operational and technical skills.
Bachelor’s degree or equivalent recent and related work experience.
Masters degree preferred.
Additional Job Information:
Aetna is about more than just doing a job. This is our
opportunity to re-shape healthcare for America and across the globe. We are
developing solutions to improve the quality and affordability of healthcare.
What we do will benefit generations to come.
We care about each other, our customers and our communities. We are inspired to
make a difference, and we are committed to integrity and excellence.
Together we will empower people to live healthier lives.
Aetna is an equal opportunity & affirmative action employer. All qualified
applicants will receive consideration for employment regardless of personal
characteristics or status. We take affirmative action to recruit, select and
develop women, people of color, veterans and individuals with disabilities.
We are a company built on excellence. We have a culture that values growth,
achievement and diversity and a workplace where your voice can be heard.
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