[Hiring] Medicare Operations Analyst @Central California Alliance for Health

Role Description

We have an opportunity to join the Alliance as a Medicare Operations Analyst with our Medicare Operations Department.

Reporting to the Medicare Operations Director, this position:

• 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.

Qualifications

• Knowledge of CMS guidelines related to Medicare sales and enrollment.
• Medicare Advantage enrollment processes and financial reconciliation.
• Contents and interpretation of monthly membership reports.
• Research, analysis, and reporting methods.
• Data analysis tools, CRM/enrollment systems, and the use of databases.

Requirements

• Ability to analyze complex data sets and present actionable insights.
• Identify issues, gather and analyze information and data, reach logical and sound conclusions, and make recommendations for action.
• Interpret, explain and apply applicable policies, laws, codes, regulations, and contracts.
• Organize work, manage multiple projects, establish priorities, adjust to changing priorities, and meet deadlines.
• Assist with the development and implementation of projects, systems, programs, policies, and procedures.
• Develop and implement operational workflows.

Education and Experience

• 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.

Compensation Information

• Zone 1 Pay Range: $82k - $95k
• Typical areas in Zone 1: Santa Cruz, San Benito, and Monterey Counties, Bay Area, Sacramento, Los Angeles and San Diego areas.
• Zone 2 Pay Range: $77k - $90k
• Typical areas in Zone 2: Mariposa and Merced Counties, Fresno area, Bakersfield, Eastern California, San Luis Obispo area, and the Central Valley (except Sacramento).

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.

Company Description

We are a group of over 500 dedicated employees, committed to our mission of providing accessible, quality health care that is guided by local innovation. We feel that our work is bigger than ourselves. We leave work each day knowing that we made a difference in the community around us.

Join us at Central California Alliance for Health (the Alliance), where you will be part of a culture that is respectful, diverse, professional and fun, and where you are empowered to do your best work. As a regional non-profit health plan, we serve members in Mariposa, Merced, Monterey, San Benito and Santa Cruz counties.