Medicare Operations Analyst

Job not on LinkedIn

🔥 2 minutes ago

🏄 California – Remote

🏄 California – Remote

💵 $77k - $95k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

⚙️ Operations

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Central California Alliance for Health

WebsiteLinkedInAll Job Openings

501 - 1000 employees

Founded 1996

🛡️ Insurance

💼 Consulting

🏥 Healthcare

Insurance • Consulting • Healthcare

Central California Alliance for Health is a regional non-profit healthcare organization that provides Medi-Cal managed care services to residents in several Central California counties, including Mariposa, Merced, Monterey, San Benito, and Santa Cruz. The organization offers a wide range of health services, including primary care, behavioral health, pharmacy support, and disease management, focusing on improving member coordination of care and access to health services. Central California Alliance for Health also engages with communities through grants and partnerships to enhance healthcare accessibility and quality. The organization supports members with services such as dental and vision care, family planning, transportation, and language assistance. Additionally, it provides resources for health education, telehealth services, and complex case management.

📋 Description

• Support Medicare operations, sales, and enrollment functions through analysis and interpretation of Medicare and Medi-Cal data • Ensure compliance with applicable state and federal regulations • Conduct complex research and analysis for Medicare Operations activities • Act as a subject matter expert and liaison to internal and external stakeholders • Identify issues, analyze data, reach conclusions, and recommend actions • Assist with developing and implementing projects, systems, programs, policies, and procedures • Develop and implement operational workflows

🎯 Requirements

• Knowledge of CMS guidelines related to Medicare sales and enrollment • Knowledge of Medicare Advantage enrollment processes and financial reconciliation • Knowledge of contents and interpretation of monthly membership reports • Knowledge of research, analysis, and reporting methods • Knowledge of data analysis tools, CRM/enrollment systems, and databases • Ability to analyze complex data sets and present actionable insights • Ability to identify issues, analyze information and data, reach logical conclusions, and make recommendations • Ability to interpret, explain, and apply policies, laws, codes, regulations, and contracts • Ability to organize work, manage multiple projects, prioritize, adjust to changing priorities, and meet deadlines • Ability to assist with developing and implementing projects, systems, programs, policies, and procedures • Ability to develop and implement operational workflows • 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; equivalent combination of education and experience may qualify • Must be currently authorized to work in the United States on a full-time, ongoing basis without current or future employer sponsorship

🏖️ Benefits

• Medical, Dental and Vision Plans • Ample Paid Time Off • 12 Paid Holidays per year • 401(a) Retirement Plan • 457 Deferred Compensation Plan • Robust Health and Wellness Program • Onsite EV Charging Stations