Medicare Consultant Job in Walnut Creek, California US
Medicare 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. This is a newly established role in the National Contract Administration Department. This role will: Partner with our Medicare and Compliance Partners in ensuring we are meeting CMS requirements. Serve as Business SME for current Medicare Initiatives Make recommendations for business guidelines and policy recommendations to be presented for executive-level decision making Manage and communicate business changes to optimize the generation of Medicare ANOC/EOC across multiple stakeholders and regional partner Lead work to provide a service for generation of our required mailing for our Medicare Members 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.