Senior Operations Analyst
7 days ago
We are seeking a highly skilled Senior Operations Analyst to join our team at HMSA. In this role, you will be responsible for supporting the administration and management of day-to-day operational activities needed to comply with CMS requirements and HMSA standards.
Key Responsibilities- CMS Compliance and Guidance
- Ensure all HMSA's Medicare Program contractual obligations and requirements are met or exceeded in appropriate operational departments.
- Interpret CMS regulations and provide operational impact guidance to departments and HMSA's contracted vendors.
- Adjust existing systems, operations, and/or workflows to adapt to the ever-changing requirements of CMS and any identified deficiencies in current program quality and administration.
- Monitor compliance via report and data validation.
- Monitor communications from CMS and determine if/how changes to operations are needed in applicable internal departments.
- Follow-up to ensure correct action was taken on a timely basis.
- Handle ad hoc questions, research issues, and provide assistance to departments to assess impact and determine best course of action.
- Complete administrative reports based on business needs, program compliance, plan performance, and as assigned.
- Advise the manager on significant matters pertaining to regulatory and reporting requirements, program compliance, or needed program changes.
- Resolve all member cases and ensure CMS timeliness and accuracy requirements are met.
- Conduct quality assurance and process improvement reviews to assess compliance and verify appropriate actions are taken.
- Coordinate, develop, and help implement Medicare Program policies and procedures to operationalize CMS requirements affecting multiple departments.
- Maintain understanding of Medicare program operations as it relates to marketing, membership enrollment, claims processing, financial statements, customer service, provider contracting, quality improvement, utilization management, etc.
- Obtain policy clarifications/additional guidance, coordinate special administrative and operational requests, respond to CMS inquiries and requests for information, and coordinate CMS performance reviews.
- Participate in the development and implementation of required corrective action plans to address CMS audit and internal quality assurance review findings.
- Coordinate and monitor activities with appropriate department staff to ensure that corrective action plans are implemented timely and accurately.
- Perform all other miscellaneous responsibilities and duties as assigned or directed.
Estimated Salary: $65,000 - $90,000 per year
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