Remote Medicare Operations Planner

hcsc; United States; On-site; USD 85,000 - 110,000; Full time

Job summary

Health Care Service Corporation (HCSC) is a national remote-opportunity role dedicated to overseeing PDP Enrollment & Premium Billing operations, ensuring CMS requirements are met, and supporting audits. The position coordinates with vendors (Express Scripts) and internal partners to maintain compliant processes across the enrollment lifecycle.

Remote work is available to eligible candidates residing in authorized states; strong analytical and communications skills are essential for success in a

Qualifications

• Bachelor's Degree or equivalent experience.
• 3-4 years Medicare or government program experience in eligibility, premium billing, or healthcare operations.
• Proficiency with Microsoft Word, Excel, Outlook, PowerPoint.
• Must be self-motivated and possess the competencies required to work in a fast-paced and heavily matrixed environment
• Ability to perform responsibilities independently as well as an effective team member
• Excellent conceptual and analytical skills with the ability to identify linkage between interfacing systems and processes, identify issues and manage/execute solutions to resolution.

Responsibilities

• Support daily oversight and monitoring of PDP Enrollment & Premium Billing operations with the vendor, internal and external partners. Includes BPO vendor, Pharmacy Claim vendor (Express Scripts), and internal HCSC Business and matrix partners.
• Perform ongoing review and interpretation of new and existing CMS requirements to ensure processes are compliant with CMS.
• Monitor operational metrics, critical volumes, and daily inventory to proactively identify potential issues.
• Review Service Level Agreement (SLA) on a monthly basis and work with vendor/matrix partners to address any issues impacting enrollment and billing operations
• Manage weekly monitoring activities; pulling samples, tracking results and evidence of corrective action to support CPE audits, and prepare results reporting for leadership.
• Perform focused monitoring/audits post deployment of changes to operational processes.
• Participate in and actively support all internal, external, and CMS audit activities by quality reviewing universes, samples and all supporting documentation.
• Identify and articulate trends and issues found in monitoring and work with business partners and vendor for remediation and/or process improvements.
• Support additional duties and projects based on business needs such as AEP and 1/1 Readiness activities related to enrollment and billing.
• Support Annual review of vendor policy & procedures to ensure processes are up to date and current with CMS guidance and Company Business policies.

Skills

Medicare Part C/D experience

Analytical skills

Problem solving

Excellent communication

Team collaboration

Fast-paced environment

Education

Bachelor's Degree or equivalent experience

Tools

Microsoft Word

Microsoft Excel

Microsoft Outlook

PowerPoint

Job description

Health Care Service Corporation (HCSC) is a national remote-opportunity role dedicated to overseeing PDP Enrollment & Premium Billing operations, ensuring CMS requirements are met, and supporting audits. The position coordinates with vendors (Express Scripts) and internal partners to maintain compliant processes across the enrollment lifecycle.

Remote work is available to eligible candidates residing in authorized states; strong analytical and communications skills are essential for success in a