Senior Business Analyst -- Medicare Programs

HMSA
United States, Hawaii, Honolulu
818 Ke’eaumoku Street (Show on map)
Dec 10, 2024
As the senior level subject matter expert on Medicare plans, works closely with HMSA management, operational departments, Medicare Compliance Officers, business partners and contracted vendors to provide analysis and consulting services. Responsible to carry out the following key activities independently and with a high degree of professional competence and technical expertise: Provide leadership, training and guidance to other Medicare Programs analysts in managing work and resources to ensure routine administrative requirements and deadlines are met; proactively conduct process improvements within the department to ensure operations are efficient. Regularly communicate and interprets CMS contract requirements and program rules, perform advanced level research and analysis of Medicare program regulations, policies and contractual requirements, assess operational risks/impact to functional departments, and help develop business solutions that allow HMSA to achieve compliance and simultaneously meet business goals/objectives at the same time. Manage projects related to developing and improving the Medicare line of business, coordinate and/or facilitate planning and completion of quality assurance and monitoring activities within the Medicare Programs and/or among major functional areas. Assess compliance with internal policies, procedures and work flows and new and revised CMS requirements; work with departments to implement corrective actions as necessary to meet and/or maintain acceptable CMS performance levels. Participate in and/or lead cross functional teams to support Medicare Programs initiatives to improve our medical, drug and other health related products to ensure HMSA remains competitive in the Medicare market and meets its short term and longer term market share goals and objectives. Collaborate closely with other MP teams and the Medicare Compliance Officer to coordinate and execute CMS and other government entity reviews and CMS audits, and respond to CMS warning letters and Notices Of Non-Compliance. Assess operational responses to CMS issues and perform follow-up reviews. As the a primary administrative liaison with CMS and HMSA operation management; interact with the necessary CMS personnel with appropriate tact, discretion and responsiveness to obtain favorable considerations when seeking policy clarifications, guidance, making special administrative and operational requests, and replying to CMS inquiries and requests for information. Seek opportunities to collaborate and innovate with other departments, Blue Cross Blue Shield Association and Plans, HMSA partners, vendors and downstream entities to continuously add value and support HMSA's drive to excellence goals in affordability, quality care, customer experience and healthiest membership .membership. Performs all other miscellaneous responsibilities and duties as assigned or directed. #LI-Hybrid