Duties Include
1.Review transactions to ensure accuracy of transaction and system processing. Provide timely documented feedback on issues identified at the processor and / or system level and execute escalation procedures if applicable.
2.Ability to assess CMS Medicare Advantage regulations and required controls and incorporating what is required into the specifications and / or documentation.
3.Identify process improvements and develop workflow and / or system recommendations.
4.Support CMS program audits; including research claims related issues / questions and preparation of appropriate audit responses as well as represent IBX in the audit presentation to CMS.
5.Support assigned projects related to Medicare Advantage products, maintain appropriate documentations at a task level, monitor deadlines and service as a technical liaison when appropriate.
6.Evaluate / test new or modified processes and procedures to verify that the new Medicare Advantage programs or program changes are functioning as intended and conform to established policies.
Maintain detailed testing notes, cases, and outcomes to support all findings.
7.Develop and maintain user documentation ensuring the most current information is available to the production areas.
8.Communicate effectively in writing and verbally with in work groups and internal and external customers.
9.Attend internal and external education training to achieve and maintain proficiency on all systems.
- Associate degree or minimum two-year Medicare Advantage work-related experience, bachelor’s degree preferred.
- Knowledge of systems, process flows, regulatory impacts, and timelines to ensure requirements, testing and implementation are in compliance across operational disciplines.
- Ability to compile detailed system requirements, reporting and data mining to support business needs that meet the need.
- Skilled in trend analysis and highly effective in communicating as the liaison with business partners on findings and recommendations focused on minimizing impacts to other areas and the customer.
- Superior written and verbal communication skills are required to provide business units with information and tools to support system modifications and / or new installations.
- Maintain flexibility in a team environment and identify process improvement opportunities and define system impacts that may result.
- Minimum three (3) or more years of auditing, quality review or transaction processing experience
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