Contract Administration Consultant Job in Walnut Creek, California US
Contract Administration Consultant
National Contract Administration is a function in Kaiser Permanente responsible for standardizing and improving the processes that produce the many important benefit and coverage documents we send to our members and employers. This function is responsible for ensuring compliance with the multiple benefit and coverage documents required by the Federal and State Agencies. The Affordable Care Act published its final regulations on 02/06/12 requiring issuers and Group Health Plans to comply with the standards developed by the US Department of Health and Human Services (HHS) for a summary of benefits and coverage (SBC) explanation for individual and group health insurance (including HMO and Self-Funded plans). As a Federal requirement, this applies to all regions supported by Kaiser Permanente. This regulation mandates that all health insurance issuers provide a summary of benefits and coverage that follows the standards provided by HHS to every applicant, enrollee, and policy, or contract holder. There are 2 Phases for implementation of this provision: the first phase is effective 09/23/12 and the second phase is for Plan Year beginning 2014. This role will: Partner with our Legal and Compliance Partners in ensuring we are meeting HHS requirements for SBC Develop and maintain detailed Operating Assumptions that will be followed for SBC Program-wide, for all regions. Engage with multiple stakeholders from Sales and Management, Underwriting, Benefits Administration, Health Plan Regulatory Services, Member Services, in understanding and defining detailed operational implications of implementing the HHS standards Partner with our Group and Kaiser Permanente Individual and Family (KPIF) National and Regional stakeholders to define initial and subsequent (Phase 2) detailed business requirements Develop business guidelines to ensure compliance for Program-wide, for all regions Engage with our Go To Market Team as we work with Employer Groups in ensuring we meet the joint accountability assigned by HHS to both the Issuer and the Employer Group Make recommendations for policy recommendations to be presented for executive-level decision making Partner with the Benefits Administration PMO and implementation teams responsible for building the functional specifications, designing and implementing the SBC solution Manage and communicate business changes to optimize the generation of SBC across multiple stakeholders and regional partner Serve as Business SME for SBC Qualifications: Basic Qualifications: - Total of ten (10) years, to include three (3) or more years in a consulting role. - Five (5) years experience in healthcare environment or five (5) plus years of experience working in a department relevant to the current posting. - Bachelor's degree in health care administration or related discipline. - Preferred certification or advanced qualification by third party association that matches the function or field applicable to the business discipline (such as AHIP or HIAA). - Preference for certification by professional society or industry group such as AHIP or HIAA. - Influences multiple cross-functional and/or multiple cross divisional task forces to identify and document functional requirements, workflow, information sources and system/process specifications. - May establish cross-functional task forces. - Thorough knowledge of platforms of the assigned functional areas and multiple cross functionally based on assignment. - Promulgates test plans. - Provides subject mater expertise to cross-divisional, common business areas. - Make recommendations regarding business strategy and policy development. - Sets and works to meet challenging goals that will improve performance of project team or organization unit. - Assesses the needs of a job and objectively matches the strengths of a person to that job to ensure maximum performance and results. - Makes fact-based decisions, sets priorities or chooses goals on the basis of calculated inputs and outputs (i.e., potential profit, return-on investment, EVA, or cost-benefit analysis). - Measures and tracks key business results and processes against external best practices and assess improvement in these terms. - Stands by decisions that benefit members/customers even if they are unpopular or impact short term performance. - Defines and articulates strategies and changes based on their impact on customer/member satisfaction. - Demonstrates primary commitment to member/customer needs (before other requirements), intervening and taking dramatic action as needed. - Eliminates duplication and aligns systems across a market or service area to balance resources and ensure the delivery of quality member/customer service and care. - Maintains a view of multiple complex internal and external variables and interrelationships that impact Kaiser Permanente. - Uses organizational strategy as a framework for developing strategy for a particular market, service area or function. - Consistently makes decisions recommendations and takes actions which fully support targeted strategic changes, thinking three (3) or more years out. - Comment: Consultants make recommendations, operational managers make decisions.