Medicare D Plan Management Advisor Job in Scottsdale 85260, Arizona US
Business advisor will work as part of the SilverScript / Accendo / CMS account management team. SilverScript / Accendo / CMS account team has direct interface with Centers for Medicare and Medicaid and receives all CMS related issues that have not been resolved through other issue resolution channels such as CTM (complaint tracking module or grievances channel). Business advisor will provide a CMS perspective on issue resolution; develop in-depth understanding of an issue to ensure Accendo and SilverScript accurately conveys the situation to CMS; and, works closely with Key Management individual on issues. Critical thinking, project management duties and whole systems approach to problem solving is essential. This is a fast paced environment where meeting CMS deadlines and providing substantive project information is critical.
Essential Job Functions:
- Responsible for managing numerous cross functional projects, as related to CMS reportable issues. Present project status updates at weekly CMS meetings and daily leadership meetings.
- Work with Key Management staff to fully document cross functional issue reports. Ensure report is written in accordance with CMS standards, in-depth analysis is conducted, that a whole systems approach has been taken to resolve issue, and that the project plan is measurable and auditable.
- Key spokesperson to CMS on behalf of Accendo and SilverScript Insurance Company, verbal and written, about Plan issues/projects.
- Manage highly visible issues to Congressional Offices, all CMS Regional Offices and Central Office.
- Liaison with internal business partners, Legal, Compliance to develop response to escalated CMS inquiries.
- Must be versatile in problem solving, will work issues related to any part of Medicare Part D program; for example, Customer Service, Benefits, Appeals, Formulary, Claims.
- Ensure CMS regulated turnaround times are met, escalate prior to missing deadlines, and convey time requirements and urgency to internal business partners when working together on a CMS related issue. Attend leadership committee reviews as needed and be prepared for discussion.
- Project manage multiple issues, track progress, and deliverables in accordance with CMS mandated deadlines.
- Access internal systems and CMS system (MARx) for research and problem solving.
- Elicit business reports, requirements and processes as part of issue resolution and closure.
- Validate issues have been fully resolved by conducting ad hoc data and workflow analysis.
- Identify issue trends and cross correlate to metric monitoring reports, Complaint Tracking issues (CTM), grievances, prior audit findings, Star Performance Ratings.
- Identify process and quality improvement recommendations, interface with process improvement team for implementation.
- Interface with any business unit within Medicare Part D program as needed.
- Work with CMS issue database administrator on regular weekly basis. Pull ad hoc reports from database for leadership review.
- Create CMS meeting presentations.
- Bachelor’s Degree and/or Equivalent degree and/or work experience required.
- Advanced Degree is preferred.
- HealthCare Compliance Certification is a plus.
- 9 years healthcare or health insurance or CMS programs. Experience in management or project management.
- Project management experience across multiple business units.
- Strong organizational and communication skills; a self starter.
- Familiarity with Medicare Part D.
- Experience and proven success in interfacing with diverse teams and complex projects.
- Experience in business planning, workflow process, quality control monitoring.
- Strong analytical, interpersonal and public speaking skills.
- Experience and proven use with: excel, powerpoint, visio, word, access.
- Understand the urgency in meeting CMS regulated turnaround times and work accordingly.
- Must be comfortable in an environment that quickly moves from one issue to the next that requires fast interface with internal partners, and exhibit the ability to discern an issue which requires immediate escalation to leadership.
