Medicare Program Coordinator

Moda Health; Portland (OR); Remote; USD 60,000 - 80,000; Full time

Job summary

A leading healthcare company in Oregon seeks a Medicare Program Coordinator to enhance compliance and operational functions. The candidate will manage training, audit processes, and policy analysis while working collaboratively across departments. This full-time position emphasizes compliance and effectiveness within the Medicare program, providing a meaningful opportunity in healthcare leadership.

Benefits

Medical, Dental, Vision, Pharmacy Coverage

401K Matching

FSA Benefits

Employee Assistance Program

Paid Time Off and Holidays

Qualifications

• Minimum of two years Medicare Advantage Health Plan experience.
• Working knowledge of Medicare and CMS rules.
• Ability to develop and train effectively.

Responsibilities

• Analyze and communicate new Medicare policies.
• Support product launch efforts and maintain compliance.
• Coordinate audits and operational integrity.

Skills

Interpersonal Skills

Analytical Skills

Communication Skills

Organizational Skills

Team Collaboration

Education

Bachelor's Degree or Equivalent Experience

Tools

Microsoft Office Suite

Job description

Let’s do great things, together!

About Moda

Founded in Oregon in 1955, Moda is proud to be a company of real people committed to quality. Today, like then, we’re focused on building a better future for healthcare. That starts by offering outstanding coverage to our members, compassionate support to our community and comprehensive benefits to our employees. It keeps going by connecting with neighbors to create healthy spaces and places, together. Moda values diversity and inclusion in our workplace. We aim to demonstrate our commitment to diversity through all our business practices and invite applications from candidates that share our commitment to this diversity. Our diverse experiences and perspectives help us become a stronger organization. Let’s be better together.

Position Summary

The Medicare Program Coordinator serves as the Medicare knowledge liaison to the operational departments. The Medicare Program Coordinator researches complex issues and questions, provides training and initiates audits to identify and address barriers and business gaps, making recommendations for improving compliant operational outcomes. This is a full-time WFH position.

Pay Range

$30.13 - $37.66 hourly (depending on experience)

• Actual pay is based on qualifications. Applicants who do not exceed the minimum qualifications will only be eligible for the low end of the pay range.
  
  

Please fill out an application on our company page, linked below, to be considered for this position.

https://j.brt.mv/jb.do?reqGK=27757148&refresh=true

Benefits

• Medical, Dental, Vision, Pharmacy, Life, & Disability
• 401K- Matching
• FSA
• Employee Assistance Program
• PTO and Company Paid Holidays
  
  

Required Skills, Experience & Education

• Bachelor’s degree or equivalent healthcare industry experience.
• Minimum of two years Medicare Advantage Health Plan experience.
• Working knowledge of Medicare and the Centers of Medicare and Medicaid Services (CMS) rules. Medicare Advantage experience preferred.
• Demonstrated success within a rapidly changing work environment.
• Knowledge of CMS’s Health Plan Management System (HPMS) is desired.
• Ability to independently and collaboratively develop and create.
• Ability to plan and have demonstrated organizational skills to support both individual and team goals.
• Ability to instruct, motivate, and direct individuals at various skill levels over the phone, face to face and in a classroom environment.
• Demonstrated strong, effective and diplomatic interpersonal skills working with employees of all levels.
• Analytical skills which identify technical needs and suggest an effective course of action.
• Working knowledge of Microsoft Office suite
• Excellent reading, verbal and written communication skills.
• Maintain confidentially and project a professional business image, in both face to face and telephone encounters.
  
  

Primary Functions

• Analyze and communicate new Medicare policy and regulations as they are released and assign to appropriate business unit(s) for implementation.
• Maintain current with Medicare’s changing rules by reading all Health Plan Management System (HPMS) and CMS Chapter releases.
• Support efforts related to product launch including creating member materials, attend/facilitate sub-team meetings, and perform competitive research.
• Responsible for working with outside entities, including vendors, external consultants, and CMS to achieve the company’s goals and compliance with regulatory requirements.
• Knowledgeable in the end to end business processes of an assigned unit.
• Work with the business unit to develop and review materials the unit is using for the staff training of Medicare regulations and rules.
• Facilitate operational integrity through auditing of business unit tasks. Conduct regular and ongoing validation of all relevant standards, guidelines, contractual provisions, to which the company must comply.
• Administer internal monitoring procedures that assess operational performance metrics against CMS standards.
• Maintain and update appropriate reporting to include dashboards, tracking logs, and summary reports that communicate status of the program to leadership.
• Administrator of Medicare Work plan; assigning tasks to appropriate business areas and monitoring to completion.
• Facilitate cross-departmental business unit meetings as needed, for providing instruction or serving as resource.
• Coordinate, track, and document regular and ad-hoc submissions to CMS and other regulatory agencies.
• Partner with operational areas for various CMS audit preparation, assisting in the preparation of any Corrective Action Plans.
• Provide input to operational areas regarding content of their Medicare related Policies and Procedures.
• Participate in cross-departmental projects and endeavors as assigned.
• Work closely with the business areas to research and resolve complex issues.
• Responsible for quality and continuous improvement within the job scope.
• Perform other duties as assigned.
  
  

Working Conditions & Contact With Others

• Office environment with extensive close PC and keyboard work, constant sitting, and phone work. Must be able to navigate multiple screens. Work in excess of 40 hours per week, including evenings and occasional weekends, to meet business need.
• Internally with staff members from multiple departments, as well as externally with CMS auditors and/or vendors when assigned.
  
  

Together, we can be more. We can be better.

Moda Health seeks to allow equal employment opportunities for all qualified persons without regard to race, religion, color, age, sex, sexual orientation, national origin, marital status, disability, veteran status or any other status protected by law. This is applicable to all terms and conditions of employment, including recruiting, hiring, placement, promotion, termination, layoff, recall, transfer, leaves of absences, compensation, and training.

For more information regarding accommodations, please direct your questions to Kristy Nehler & Danielle Baker via our [e-mail] email.