Note: The job is a remote job and is open to candidates in USA. Central California Alliance for Health is an award-winning regional Medi-Cal managed care plan that provides health insurance for various demographics. They are seeking a Medicare Membership & Eligibility Analyst to support Medicare operations and ensure compliance with regulations through data analysis.
Responsibilities
- Supports Medicare operations, sales, and enrollment functions through analysis and interpretation of Medicare and Medi-Cal data and ensures compliance with applicable state and federal regulations
- Conducts complex research and analysis in support of Medicare Operations activities
- Acts as a subject matter expert and liaison to internal and external stakeholders
Skills
- 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 the use of databases
- Ability to analyze complex data sets and present actionable insights
- Ability to identify issues, gather and analyze information and data, reach logical and sound conclusions, and make recommendations for action
- Ability to interpret, explain and apply applicable policies, laws, codes, regulations, and contracts
- Ability to organize work, manage multiple projects, establish priorities, adjust to changing priorities, and meet deadlines
- Ability to assist with the development and implementation of 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; or an equivalent combination of education and experience may be qualifying
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
- And [**many more**](https://thealliance.health/wp-content/uploads/benefits-guide-2023.pdf)
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