Medicare Operations Analyst (Temporary)

ASSOCIATION FOR COMMUNITY AFFILIATED PLANS; Washington (District of Columbia); Hybrid; USD 4,959,360 - 6,612,480; Full time

Job summary

ASSOCIATION FOR COMMUNITY AFFILIATED PLANS is seeking a professional to support Medicare operations in Washington, DC. This position involves analyzing Medicare data, ensuring regulatory compliance, and liaising with various stakeholders.

The ideal candidate will have a Bachelor's degree in related fields, at least five years of experience in Medicare operations, and strong skills in data analysis and project management. This role offers a hybrid work environment and is a temporary position that may lack certain benefits.

Qualifications

• Bachelor’s degree required; Master’s may substitute for two years of experience.
• Five years of experience in Medicare operations required.

Responsibilities

• Support Medicare operations and ensure compliance.
• Conduct complex research and analysis for operations activities.
• Act as a liaison to stakeholders.

Skills

Knowledge of CMS guidelines related to Medicare sales and enrollment

Medicare Advantage enrollment processes

Data analysis tools

Ability to interpret policies and laws

Project management

Education

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

Minimum of five years of experience in Medicare operations

Job description

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
• 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

Other Information

We are in a hybrid work environment, and we anticipate that the interview process will take place remotely via Microsoft Teams. While some staff may work full telecommuting schedules, attendance at quarterly company-wide events or department meetings will be expected. In-office or in-community presence may be required for some positions and is dependent on business need. Details about this can be reviewed during the interview process. This is a temporary position and does not provide the benefits that are listed below (this is standard language from our regular job posts and cannot be altered or removed). Temporary employees on assignment at the Alliance will be connected to a staffing agency with separate benefit options.

Compensation Information

Zone 1 Pay Range: $36.00 - $48.00. 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: $34.00 - $45.00. 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 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. You can reach out to [e-mail], and a member from our Talent Acquisition team will be in touch. The posted hiring ranges represent a good-faith estimate of what a temporary employee would be paid on this assignment. 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).