Department: Federal Programs -
Responsible for assisting and supporting management in the evaluation, recommendation, establishment, implementation and analysis of new and improved production workflows, work processes for systems,
reporting and new products/programs to improve customer service levels and overall quality.
Assist and support in the planning, coordinating, developing and implementing of approved projects which are Divisional and/or Corporate in scope in order to enhance the overall efficiency of operational procedures, methods, controls, and performance. Analyze, process and/or expedite operational transactions; this may include timely resolution of problems. Participate in systems testing, develop procedures/controls and provide recommendations for the ongoing improvement of the updated process. Provide leadership team with status of projects; issue, communicate and recommend policy decisions to achieve project objectives. Utilize and maintain available corporate production and reporting systems; produce routine and non-routine reports, presentations, letters communications and graphics. Assist personnel (both internal and external) by answering questions, supplying information and training. Represent department and division as requested on work groups and special assignments. Develop and maintain an effective working relationship with customers or partners. Other duties may be assigned.
Ensure state of readiness for future Government audits related to BCBSM's MA and Part D Products. Provide direct support to Audit Readiness and Policies & Procedures functions as well as department responsibilities related to the analysis and interpretation of Medicare regulations, policies and compliance tracking.
Bachelor's Degree in related field preferred.
Two (2) to five (5) years experience in related field is required.
Demonstrated knowledge/competency in the following areas: claims or inquiry processing experience preferred, analytical experience, ability to produce statistical information from conceptual needs, and working with PC application and/or mainframe systems preferred.
Effective verbal and written communication skills.
Ability to lead and contribute to process improvement programs.
Excellent interpersonal skills necessary to interact with all levels of all personnel.
Other related skills and/or abilities may be required to perform this job.
Demonstrated experience in: analyzing healthcare products, policies and programs; making decisions within scope of responsibility where operational guidelines/procedures are non-existent; problem solving and critical thinking; prioritizing multiple assignments; and developing processes, workflows and presentations.
Knowledge of Federal Programs functions and BCBSM's MA products.
Ability to demonstrate a high level of engagement in all assignments in an ever-changing environment.
Team player and independent thinker.
Excellent organizational, interpersonal and communication skills. ce.
This person will be responsible for doing the following:
Granting/Removal and reconciliation of system access for non-BCBSM applications that support the MA and Part D programs.
Review and annual monitoring for program policies and procedures.
Oversight reviews of business partner performance reports for compliance to program regulations.
Support for distribution of program communications to impacted business partners.
Follow up support for program implementations as required by CMS.
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