Medicare Operations ConsultantPrimary Location: Moon township, PA
Additional Locations: PA-Moon township Apply
68972Fundamental Components: Serves as subject matter expert for the operational functions of Medicare products within an assigned market. Assists with the execution of all CMS required activities and processes including the accuracy and compliance of the annual bid application, expansion application, member materials, and group setup. Supports internal and external Medicare audit activity including CMS and operation integrity audits. Coordinates file pulls, data requests, universe development, and supporting documentation. Maintains an awareness of trends, developments, and governmental regulations in Medicare and managed health care organizations. Provides consultative support for Medicare product design features, integration schedule, and operational readiness in a new product start-up environment. May participate on various committees to represent the Medicare Department including NCQA, Internal Research, UM/QI, Trend/MER, Risk Mitigation, Complaint and Appeals, bid, implementation, and migration. Supports member retention activities, including development of outreach materials, 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. Performs other related duties as assigned. Background Experience: Able to effectively coordinate multiple projects and programs in a matrix environment and work independently.Excellent consulting and leadership skills.Familiarity with regulations and statutes impacting the managed care environment.Ability to perform analysis and legal research to identify and clarify issues.Previous experience (5-7 years) in Medicare Operations and/or Medicare compliance functions.Excellent communication, interpersonal and presentation skills.Proficiency with standard corporate software applications, including MS Word, Excel, Outlook and PowerPoint, as well as some special proprietary applications. Bachelor's degree desired or equivalent work experience. Required Skills: General Business - Applying Reasoned Judgment, Leadership - Developing and Executing Strategy, Service - Improving Constituent-Focused Processes Functional Skills: Customer Service - Call center monitoring & analysis - Inbound calls - call center location, Management - Management - Operations, Project Management - Issue identification and analysis Technology Experience: Aetna Application - Avaya Interaction Center, Database - Intuit QuickBase, Desktop Tool - TE Microsoft Excel Potential Telework Position: No Percent of Travel Required: 0 - 10% EEO Statement: Aetna is an Equal Opportunity, Affirmative Action Employer Benefit Eligibility: Benefit eligibility may vary by position. Candidate Privacy Information: Aetna takes our candidate's data privacy seriously. At no time will any Aetna recruiter or employee request any financial or personal information (Social Security Number, Credit card information for direct deposit, etc.) from you via e-mail. Any requests for information will be discussed prior and will be conducted through a secure website provided by the recruiter. Should you be asked for such information, please notify us immediately.
Jobs for you
Recently Viewed Jobs
You do not have any recently viewed jobs
Your Saved Jobs
You do not have any saved jobs
Sign up for Job Alerts
Join our Talent Community
At Aetna, a CVS Health Company, we are pioneering a total approach to health and wellness and we need talented candidates like you to join our team. Become a member of our talent community to be the first to know about career initiatives that match your skills and interests as they become available, in addition to details on upcoming events, networking opportunities, and news about Aetna, a CVS Health Company.Sign Up
Join Our Talent Community
Sign up to receive information about job openings that are tailored to your skills and interests. Plus, get the latest career news from Aetna, a CVS Health Company.