Medicare Operations Analyst: DSNP Implementation & Compliance

Partnership HealthPlan of California; Fairfield (CA); On-site; USD 107,000 - 139,000; Full time

Job summary

Partnership HealthPlan of California is seeking a Medicare Operations Analyst to ensure operational excellence across delegated entities during implementation and post-Go-Live for Medicare DSNP programs.

You will oversee enrollment, claims processing, UM/CM, and call center performance, monitor CMS compliance, and collaborate with partners to meet CMS regulations and contractual requirements while reviewing operational reports regularly.

Qualifications

• Bachelor’s degree in healthcare administration, Business, or related field (or equivalent experience).
• 8+ years of health plan operations experience; 3–5 years Medicare DSNP operations.
• Strong knowledge of CMS regulations; auditing, compliance monitoring, and performance reporting.

Responsibilities

• Validates CMS enrollment rules, effective dates, transaction codes, and disenrollment procedures.
• Monitors enrollment files and reconciliation processes to ensure timely and accurate member onboarding.
• Reviews vendor logic for ID cards, ANOCs/EOCs, welcome kits, and PCP assignments.
• Validates fee schedules, OON rules, and prior authorization linkages.
• Reviews CMS call handling and compliance with language access and interpreter processes.
• Develops test plans for unit, system, integration, regression, and UAT during implementation.
• Supports readiness for CMS audits and compliance reviews.

Skills

CMS regulations

Auditing

Compliance monitoring

Performance reporting

Project management

Education

Bachelor’s degree in healthcare administration, Business, or related field

Job description

Partnership HealthPlan of California is seeking a Medicare Operations Analyst to ensure operational excellence across delegated entities during implementation and post-Go-Live for Medicare DSNP programs.

You will oversee enrollment, claims processing, UM/CM, and call center performance, monitor CMS compliance, and collaborate with partners to meet CMS regulations and contractual requirements while reviewing operational reports regularly.