Responsible for leading the development and implementation of programs and strategies by identifying insights that enhance business decision making capability. This includes developing or changing workflows and implementing process improvements to enhance organizational products, programs and service to our customers.

1. Identify and analyzeoperational data and develop insightsin support of business objectives.
2. Identify CMS changes by reviewing CMS transmittals and other related documents to ensure changes are implemented and tested.
3. Identify benefit and payment policy impacts to ensure all enhanced benefits are implemented and tested. This includes reviewing, testing, and implementing accurately by effective date.
4. Interpret CMS guidelines, transmittals, CMS Code Set updates and ensure all changes are tested and implemented accurately by effective date.
5. Maintain & load CMS Fees schedule.
6. Identify, implement, and test all special pricing changes, including general CMS pricing.
7. Investigate and resolve pricing or claims editing issues.
8. Work with MA Claim teams to review test claims from Advantasure/NASCO/Facets
9. Recommend and assistwith implementing standardpolicies and procedures to support the goals of the department.
10. Develop and improveworkflows and business processes within defined areasto ensure CMS compliance, improve customer service, decrease operational costs, and improve overall quality.
11. Identify and/or analyzebusiness problems and develop recommendations for solutions to problems.
12. Lead the development and implementation of projects and/orteams to producedesired results, if required.
13. Document and communicate projectconcepts, milestones, and results.
14. Ensure that corporate compliance is communicated, implemented, and monitored on an ongoingbasis.
15. Participate in systemstesting, develop procedures/controls and provide recommendations for the ongoing improvement of the updated process.
16. Provide support and collaborate with internaldepartments and externalentities by working jointly to resolve issues, identify problems, answering questions, supplying information and training.
17. Create and present reportsand presentations to display operational data, propose business changes, and provide on-going status reports to leadership.

"Qualifications"

• Bachelor's Degree in a related field is preferred.
• Four (4) years of experience in a related field is required.
• Excellent analytical and problem-solving skills to identify, evaluate, recommend and implement changes to processes or procedures to address problems and improve departmental effectiveness.
• Organizational skills and ability to prioritize; must be able to lead multiple activities with varying timelines.
• Excellent verbal, written communication and interpersonal skills.
• Ability to lead and contribute to business unit and/or corporate projects.
• Proficient in Microsoft Office Suites.
• Ability to develop and maintain effective working relationships.
• Knowledge of CMS guidance is preferred.

All qualified applicants will receive consideration for employment without regard to, among other grounds, race, color, religion, sex, national origin, sexual orientation, age, gender identity, protected veteran status or status as an individual with a disability.