Lead Analyst - Coordination Of Benefits- Servicing

SUMMARY:

The Analyst applies analytical and leadership skills to manage workflow, and track and report operational performance for COB Part C/D and Recovery activities. This position leads the implementation of new processes and enhancements to improve performance and quality. Executes control validation oversight and analyzes data to ensure quality and CMS requirements are met. This role also utilizes strong CMS Medicare Advantage, Prescription Drug, and MSP (Medicare Secondary Payer) knowledge to train, coach, and provide feedback on team performance. This position also executes the verification of coverage survey campaign.

RESPONSIBILITIES/TASKS:

• Executes the verification of coverage survey campaign and managed all reporting with the vendor and customer.
• Establishes and manages workflow. Monitors, tracks, and reports Part C/D COB and Recovery activities. Ensures timeliness is met and expected outcomes achieved.
• Leads the implementation of new processes and policy requirements.
• Leads the identification of process improvement opportunities. Identify barriers and lead the development of solutions.
• Supports control validation oversight and analyze data to ensure quality and maintain compliance with CMS requirements and BCBSM MA policies.
• Supports vendor oversight and operations for contracted services.
• Trains, coaches, and mentors team members. Provides feedback on team performance.
• Performs data reconciliation.
• Researches and resolves complex inquiries.
• Executes department functions as needed.
• Serves as a subject matter expert regarding CMS and BCBSM MA policies related to COB and Recovery. Represents the department on cross departmental work groups and committees.
• Assists leadership in analyzing data and reporting findings.
• Performs other related duties as assigned.

This position description identifies the responsibilities and tasks typically associated with the performance of the position. Other relevant essential functions may be required.

EMPLOYMENT QUALIFICATIONS:

EDUCATION OR EQUIVALENT EXPERIENCE:

Bachelor's degree in related field required or equivalent experience including Part C/D plan operations. Relevant combination of education and experience may be considered in lieu of degree. Continuous learning, as defined by the Company’s learning philosophy, is required. Certification or progress toward certification is highly preferred and encouraged.

EXPERIENCE:

Five years experience in related field. Knowledge of CMS compliance guidelines and Part C/D COB plan requirements, COB Rules of Primacy, Medicare Secondary Payer (MSP) regulations preferred. Experience establishing MSP coordination periods preferred.

SKILLS/KNOWLEDGE/ABILITIES (SKA) REQUIRED:

• Critical thinking and analytical skills; ability to take loosely formed ideas, coordinate multiple and evolve them
• Ability to work in time sensitive / rapid pace environment with shifting priorities and high exposure to Senior / Executive Leadership team
• Comfortable working in matrix environment; able to build relationships with broad cross functional team
• Ability to work with and empower others on a collaborative basis to ensure success of unit team.
• Highly organized and structured
• Ability to effectively exchange information, in verbal or written form, by sharing ideas, reporting facts and other information, responding to questions and employing active listening techniques
• Strong writing / communication skills
• Microsoft Suite with an emphasis on PPT, Excel, Word and Project
• Ability to manage and reconcile data.
• Knowledge of and/or ability to research, interpret and apply Medicare and BCBSM MA Part C/D COB policies.
• Knowledge of BCBSM MA claims, enrollment, finance, imaging and other relevant systems
• Strong organizational, problem solving, verbal and written communication skills
• Strong analytical and reporting skills with work experience
• Ability to work independently, within a team environment and with multiple priorities
• Ability to train and coach
• Ability to lead the implementation of new processes, workflows, and enhance existing operations
• Ability to work closely with the technical support team in understanding and resolving systems issues
• Ability to develop, implement, and monitor policies and procedures
• Familiarity with check posting and payment tracking
• Working knowledge of Microsoft Access, other Microsoft office applications, and related software programs.
• Medicare Advantage plan operations experience is preferred
• Project experience preferred
• Familiarity with claims coding, billing, and processing is desired
• Other related skills and/or abilities may be required to perform this job

WORKING CONDITIONS:

Work is performed in an office setting with no unusual hazards.

The qualifications listed above are intended to represent the minimum education, experience, skills, knowledge and ability levels associated with performing the duties and responsibilities contained in this job description.

PAY RANGE:

“Actual compensation decision relies on the consideration of internal equity, candidate’s skills and professional experience, geographic location, market and other potential factors. It is not standard practice for an offer to be at or near the top of the range, and therefore a reasonable estimate for this role is between $62,100 and $104,000.”

We are an Equal Opportunity Employer. Diversity is valued and we will not tolerate discrimination or harassment in any form. Candidates for the position stated above are hired on an "at will" basis. Nothing herein is intended to create a contract.

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