Medicare Operations Analyst

Central California Alliance for Health; Scotts Valley (CA); On-site; USD 82,000 - 95,000; Full time

Benefits offered by this job

Medical, Dental and Vision Plans

Ample Paid Time Off

12 Paid Holidays per year

401(a) Retirement Plan

457 Deferred Compensation Plan

Wellness Program

Onsite EV Charging Stations

Job summary

Central California Alliance for Health in Scotts Valley, CA is seeking a Medicare Operations Analyst to support Medicare operations, sales and enrollment activities through analysis of Medicare and Medi-Cal data, ensuring compliance with state and federal regulations.

Reporting to the Medicare Operations Director, you will act as a subject matter expert, conduct complex research, and collaborate with internal and external stakeholders to drive accurate reporting and efficient workflow.

Qualifications

• Bachelor's degree in a related field is required.
• Minimum of five years of progressively responsible experience in Medicare membership operations and/or enrollment.
• Master's degree may substitute for two years of required experience; or an equivalent combination of education and experience.

Responsibilities

• Supports Medicare operations, sales, and enrollment functions through analysis and interpretation of Medicare and Medi-Cal data and ensures compliance with applicable state and federal regulations.
• Conducts complex research and analysis in support of Medicare Operations activities.
• Acts as a subject matter expert and liaison to internal and external stakeholders.

Skills

CMS guidelines knowledge

Medicare enrollment processes

Membership reports interpretation

Data analysis

CRM/enrollment systems

Education

Bachelor's degree in Business Administration, Health Care Administration, Public Health, or related field

Job description

OUR COMMITMENT TO A HUMAN HIRING PROCESS

We believe every candidate deserves thoughtful consideration.That'swhy wedo not use AI or automated systems toreview applications. Every application is reviewed bya realhumanmember of our team. Because we take the time to give each submission the attention it deserves, our review process may take a little longer - and we genuinely appreciate your patience as we work through applications carefully and respectfully.

SERVICE AREA PREFERENCE

While we encourage all interested applicants to apply, we do give priority to those who live in, or near, our service counties: Santa Cruz, Monterey, Merced, San Benito, and Mariposa. Our mission ofaccessible, quality health care guided by local innovationleadseverything we do, and having team members who are connected to the communities we serve strengthens our ability to deliver on that commitment.

We have an opportunity to join the Alliance as a Medicare Operations Analyst with our Medicare Operations Department.

WHAT YOU'LL BE RESPONSIBLE FOR

Reporting to the Medicare Operations Director, this position:

• Supports Medicare operations, sales, and enrollment functions through analysis and interpretation
  of Medicare and Medi-Cal data and ensures compliance with applicable state and federal
  regulations
• Conducts complex research and analysis in support of Medicare Operations activities
• Acts as a subject matter expert and liaison to internal and external stakeholders

WHAT YOU'LL NEED TO BE SUCCESSFUL

• Knowledge of:
• CMS guidelines related to Medicare sales and enrollment
• Medicare Advantage enrollment processes and financial reconciliation
• Contents and interpretation of monthly membership reports
• Research, analysis, and reporting methods
• Data analysis tools, CRM/enrollment systems, and the use of databases

• Ability to:
  • Analyze complex data sets and present actionable insights
  • Identify issues, gather and analyze information and data, reach logical and sound conclusions, and make recommendations for action
  • Interpret, explain and apply applicable policies, laws, codes, regulations, and contracts
  • Organize work, manage multiple projects, establish priorities, adjust to changing priorities, and meet deadlines
  • Assist with the development and implementation of projects, systems, programs, policies, and procedures
  • Develop and implement operational workflows

• Education and Experience:
  • Bachelor's degree in Business Administration, Health Care Administration, Public Health, or a related field
  • Minimum of five years of progressively responsible experience related to Medicare membership operations and/or enrollment eligibility
  • Master's degree may substitute for two years of the required experience; or an equivalent combination of education and experience may be qualifying

COMPENSATION INFORMATION

• Zone 1 Pay Range: $82k -$95k
  Typical areas in Zone 1: Santa Cruz, San Benito, and Monterey Counties, Bay Area, Sacramento, Los Angeles and San Diego areas
  
• Zone 2 Pay Range: $77k - $90k
  Typical areas in Zone 2: Mariposa and Merced Counties, Fresno area, Bakersfield, Eastern California, San Luis Obispo area, and the Central Valley (except Sacramento)

The applicable salary ranges are based on work location and are aligned to a zone according to the cost of labor in your area. All ranges are subject to change in the future. We are happy to provide the full compensation range for the role, answer any questions that you have, or share the applicable pay zone for your location if it's not one of the typical areas listed.

The hiring ranges represent a goodfaith estimate of what we expect to pay for this role upon hire and are not the full compensation ranges. Employees typically have opportunities for growth within the full compensation range over time based on performance and merit. Final compensation will be determined by our compensation philosophy, analysis of the selected candidate's qualifications (direct or transferable experience related to the position, education, or training), as well as other factors (internal equity, market factors, and geographic location).

OUR BENEFITS

Available for all regular Alliance employees working more than 30 hours per week.Some benefits are available on a pro-rated basis for part-time employees. These benefits are unavailable to temporary employees while on an assignment with the Alliance.

• Medical, Dental and Vision Plans
• Ample Paid Time Off
• 12 Paid Holidays per year
• 401(a) Retirement Plan
• 457 Deferred Compensation Plan
• Robust Health and Wellness Program
• Onsite EV Charging Stations

ABOUT US

We are a group of over 500 dedicated employees, committed to our mission of providing accessible, quality health care that is guided by local innovation. We feel that our work is bigger than ourselves. We leave work each day knowing that we made a difference in the community around us.

Join us at Central California Alliance for Health (the Alliance), where you will be part of a culture that is respectful, diverse, professional and fun, and where you are empowered to do your best work. As a regional non-profit health plan, we serve members in Mariposa, Merced, Monterey, San Benito and Santa Cruz counties.

The Alliance is an equal employment opportunity employer. Qualified applicants will receive consideration for employment without regard to race, color, religion, sex (including pregnancy), sexual orientation, gender perception or identity, national origin, age, marital status, protected veteran status, or disability status. We are an E-Verify participating employer

At this time the Alliance does not provide any type of sponsorship. Applicants must be currently authorized to work in the United States on a full-time, ongoing basis without current or future needs for any type of employer supported or provided sponsorship.