Serves as subject matter expert for the implementation of all Medicare Part D and Medicare Advantage activities and programs across a market in support of the Director of Medicare Operations and Chief Medicare Officer. Provides guidance and analysis for new product start-up, program design and core health plan operations.60896
Serves as subject matter expert for the operational functions of Medicare products within the Great Lakes market. Assists with the execution of all CMS required activities and processes including the accuracy and compliance of the annual bid application, expansion application, member materials, and group setup. Supports internal and external Medicare audit activity including CMS and operation integrity audits. Coordinates file pulls, data requests, universe development, and supporting documentation. Maintains an awareness of trends, developments, and governmental regulations in Medicare and managed health care organizations. Provides consultative support for Medicare product design features, integration schedule, and operational readiness in a new product start-up environment. May participate on various committees to represent the Medicare Department including NCQA, Internal Research, UM/QI, Trend/MER, Risk Mitigation, Complaint and Appeals, bid, implementation, and migration. Supports member retention activities, including development of outreach materials, design/implementation of outreach programs both directly and in coordination with corporate member retention team, development of talking points/educational pieces about market specific issues. Monitors sales and marketing activities to assure adherence to Federal and State regulations. Performs other related duties as assigned.
Previous experience (3+ years) in Medicare Operations and/or Medicare compliance functions.
Able to effectively coordinate multiple projects and programs in a matrix environment and work independently.
Excellent consulting and business analysis skills
Familiarity with regulations and statutes impacting the managed care environment.
Ability to perform analysis and legal research to identify and clarify issues.
Excellent communication, interpersonal and presentation skills.
Proficiency with standard corporate software applications, including MS Word, Excel, Outlook and PowerPoint, as well as some special proprietary applications.
Bachelor's degree desired or equivalent work experience.
General Business - Communicating for Impact, General Business - Consulting for Solutions, General Business - Turning Data into Information
Products-Medical - Individual Medicare Advantage Plan
Desktop Tool - Microsoft Outlook, Desktop Tool - Microsoft PowerPoint, Desktop Tool - TE Microsoft Excel
Potential Telework Position:
Percent of Travel Required:
0 - 10%
Aetna is an Equal Opportunity, Affirmative Action Employer
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