Duties Include

1.Review transactions to ensure accuracy of transaction and system processing. Provide timely documented feedback on issues identified at the processor and/or system level and execute escalation procedures if applicable.

2.Ability to assess CMS Medicare Advantage regulations and required controls and incorporating what is required into the specifications and/or documentation.

3.Identify process improvements and develop workflow and/or system recommendations.

4.Support CMS program audits; including research claims related issues/questions and preparation of appropriate audit responses as well as represent IBX in the audit presentation to CMS.

5.Support assigned projects related to Medicare Advantage products, maintain appropriate documentations at a task level, monitor deadlines and service as a technical liaison when appropriate.

6.Evaluate/ test new or modified processes and procedures to verify that the new Medicare Advantage programs or program changes are functioning as intended and conform to established policies. Maintain detailed testing notes, cases, and outcomes to support all findings.

7.Develop and maintain user documentation ensuring the most current information is available to the production areas.

8.Communicate effectively in writing and verbally with in work groups and internal and external customers.

9.Attend internal and external education training to achieve and maintain proficiency on all systems.