[Hiring] Medicare Domain SME @Vir Healthway

Role Description

This Expert must be able to play a leadership role in managing and coordinating the members of the BIA team. They must have excellent interpersonal skills, be self-reliant and generate confidence to the extent that they can take increasing levels of personal responsibility in relation to delivering solutions directly to the client. They will be required to undertake project management duties and lead work streams, participate in RFP responses, change request proposal development, provide product demonstration and perform user acceptance testing.

Qualifications

• BA/BS degree in business/accounting/finance or equivalent experience.
• Thorough experience of Medicare Advantage health plan operations around:
• Eligibility and Enrolment
• CMS guidelines
• Member correspondence
• Medicare operations workflow
• Premium billing
• Capitation Revenue reconciliation
• 10+ years' experience with customer relations activities, including:
• Business process management
• Issue management
• Ability to define desired outcomes and solutions
• 10+ years' experience documenting requirements gathering sessions, processes, procedures, user manuals, and outcomes.
• 10+ years' experience developing test criteria and executing the test process.
• Should have hands-on experience writing basic SQL queries.
• Excellent organizational skills and attention to detail, with the ability to multi-task and prioritize.

Requirements

• Medicare SME
• Medicare Advantage
• Enrolment
• Premium Billing
• CMS Guidelines
• Capitation Revenue reconciliation
• Member correspondence
• Medicare operations workflow

Company Description