Medicare and Medicaid Premium Analyst

Tracking Code 812-124

Job Description

Discovery Health Partners offers payment and revenue integrity solutions that help health payers improve revenue, avoid costs, and enhance the member experience. We offer a unique combination of deep healthcare expertise and analytics-powered technology solutions to help our clients improve operational efficiency, achieve financial integrity, and generate measurable results. This role is responsible for establishing, maintaining, and coordinating a new Premium Restoration Solution for the Eligibility team for Medicare and Medicaid plans. The incumbent will work cross-functionally with other departments to organize and develop new premium restoration solutions to deliver increased restorations to Medicare and Medicaid health plans. This individual will establish goals, timelines, processes and objectives for developing new solutions and concepts. JOB ROLES AND RESPONSIBILITIES:

• Lead premium restoration solution development for health plan clients for Medicare and Medicaid lines of business
• Establish KPIs and relevant business metrics for new premium restoration solutions
• Coordinate strategies to improve existing premium restoration solutions
• Acts as a subject matter expert for internal and client facing discussions regarding Medicare and Medicaid products
• Sets and implements strategies for process efficiencies, cost reduction, quality improvement, and enhanced client experience
• Identifies, recommends, and develops process improvements, including providing oversight and direction for all new premium restoration solutions
• Works with other departments to develop concepts, operations documents and policy and procedures
• Develops and implements effective ways to find and reduce gaps with premium restoration clients
• Executes in matrix environment to deliver new solutions to production
• Collaborate, coordinate, and communicate across disciplines and departments.
• Ensure compliance with HIPAA regulations and requirements.
• Demonstrate Company’s Core Competencies and values held within.
• Please note due to the exposure of PHI sensitive data – this role is considered to be a High Risk Role.
• The position responsibilities outlined above are in no way to be construed as all encompassing. Other duties, responsibilities, and qualifications may be required and/or assigned as necessary.

This role will require the individual to work independently to research and review potential new premium restoration and eligibility management solutions for Medicare and Medicaid plans. The role will require the individual to coordinate with other departments such as marketing, sales, account management and IT to coordinate proof of concepts and strategies to Medicare and Medicaid plans. Required Skills

• Minimum high school diploma plus three (3) years’ experience in healthcare operations. Bachelors’ degree in a related field is preferred.
• Government health plan experience strongly preferred (eligibility, payment integrity, claims)
• Excellent organizational, analytical and independent decision-making skills
• Demonstrated problem solving skills with the ability to manage multiple priorities and meet associated timelines
• Ability to anticipate needs and solve problems proactively in a fast paced, rapidly changing environment
• Ability to learn quickly and work independently within time constraints
• Adept knowledge of Microsoft Word, Excel and Outlook; Excel proficiency required (pivot tables, VLookup, data analysis and data reporting)
• Logical, clear and concise written and verbal communication skills
• Individual in this position must be able to work in a standard office environment which requires sitting and viewing monitor(s) for extended periods of time, operating standard office equipment such as, but not limited to, a keyboard, copier and telephone

Job Location Remote, United States Position Type Full-Time/Regular Apply tot his job Apply To this Job