The Coordinator, Medicare Program Projects provides technical, clerical and operational support to the Progr Mgr, Health Plans in the development, implementation, maintenance and continuous improvement of new and extant Medicare programs and projects. Provides the operational support of Medicare Programs ongoing programs. Disseminates HPMS memos, maintains files, database and documentation of project implementation and verifications, submits reports to CMS and maintains all documentation. Provides administrative support to the annual CMS Bid submission, periodic Service Area Expansions, Call letter implementation, annual readiness review attestation, etc.). Reviews submitted materials for quality, accuracy and completeness and making recommendations to Manager regarding the acceptance and/or modifications necessary for these materials. Assists with identifying, compiling and disseminating legislative and regulatory trends and initiatives that impact Medicare, Medicare Advantage and Medicare Advantage Dual SNP programs. Serves as a first line resource for navigating CMS regulations, sub-regulator guidance and policies, and is responsible for recommending and advising the functional areas and the Manager regarding impact on operations.
Disseminates CMS regulatory, sub-regulatory and policy guidance in a timely manner and receives verification and documentation that such guidance is strictly adhered to and implementation verified. Independently reviews evidence of implementation and advises functional areas and the Manager on the veracity of the evidence. This includes but is not limited file/administrative management of HPMS Memos, the annual Call Letter, Managed Care Manual Chapter changes and updates, the annual readiness checklist.
Assists with the annual CMS Bid process. Performs independent QA of the submission and advises Manager on the results with recommendations of corrections as appropriate.
Provides technical and operational support and processing of the annual Service Area Expansion process as necessary. Performs independent QA of the submission and advises Manager on the results with recommendations of corrections as appropriate.
Submits or monitors all required materials and data to CMS via HPMS. Collects materials from the functional area (in which case the Manager will facilitate and verify) and assists as necessary. Performs independent QA of the submission and advises Manager on the results with recommendations of corrections as appropriate. This includes but is not limited to formulary submission, annual website update, marketing materials, LIS match Rates, Monthly Encounter Data (formerly RAPS), Part C and Part D Reporting.
Provides support for the following: the development of the New Member Notifications (e.g. ANOC, EOC), development and production of all member materials, maintenance of most current model member communications, attends all relevant CMS user group calls, project management of the annual Data Validation process.
Serves as resource for Annual 5 Star plan. Compiles and disseminates legislative and regulatory trends and initiatives that impact Medicare, Medicare Advantage and Medicare Advantage Dual SNP programs. Assists with project management and monitoring of Model of Care requirements and processes.
Assists with the production of Monthly Operational Dashboard (actual production of data comprising dashboard is the responsibility of the functional areas). Assists with ensuring functional areas are compiling and reporting the data that comprise the Monthly Medicare Compliance Dashboard.
Assists with the annual Medicare Product implementation workgroup.
Knowledge, skills and abilities as normally obtained through the completion of a bachelors degree and one year experience working in an office environment.
Knowledge of record management best practices, project coordination and database development and maintenance and knowledge of Medicare and Medicaid managed care practices and regulations.
Skill in communicating with all levels of the organization, oral and written communication skills, and skill in building and maintaining interpersonal relationships. Skill in the use of computer applications including Microsoft office products and EXCEL.Ability to organize and execute programs, work independently ensuring all deadlines are met. Ability to be flexible in order to work on a variety of initiatives simultaneously under tight time constraints and to work cross functionally across the organization and to use critical thinking in resolving problems and conflicts. Ability to grasp new knowledge and concepts quickly and apply them
One to two years experience of health care administrative support experience, one to two years of other administrative support experience, one year of project coordination/project management experience preferred.
Additional related education and/or experience preferred.
You want to change the health care industry – one life at a time. You belong here. You’re excited to be part of the dramatic changes happening in the health care field. In fact, you thrive on change. But you also understand that excellent, compassionate patient care is the true measure of the success of these changes. You belong at Banner Health. Our award-winning, comprehensive health system includes 23 hospitals in seven western states, primary care health centers, research centers, labs, a network of physician practices and much more. Throughout our system, skilled, compassionate professionals use the latest technology to change the way care is provided. If you’re looking to be a key contributor to a forward-looking organization, you’ll experience a wide variety of professional advantages: •Our vision for changing the future of health care gives you the opportunity to leverage your abilities to achieve something historic. •Our expansive system offers you an unmatched variety of clinical settings – from large urban trauma center to small rural hospital, ambulatory to home health. Our system also includes hospitals specializing in cancer, heart health and pediatrics. •Our many loc...ations also translate into a broad selection of exciting and rewarding lifestyle options – from the big city to the wide-open spaces. •Our commitment to healthcare innovation means you always have the latest technologies at your fingertips to help you provide the finest care possible. •The size, success and growth of our system provide you with the stability and options to pursue your desired career path. •Our competitive compensation and comprehensive benefits offer you options to complement your unique needs.