Medicare Compliance Analyst

Summary/Position Objectives:
This position reports to the Director of Compliance and supports general and Medicare-focused compliance and reporting requirements, and helps support the Medicare Program Director as Schaller Anderson expands its Medicare line of business, both at the corporate and health plan level.

Responsibilities:
Essential Functions:
Leads health plan Affiliates as and when required, and coordinates project management for all (corporate management and Affiliate plan oversight) Medicare development and implementation activities focusing primarily on:
Enrollment; Claims; Marketing; all Part D (e.g., Prior Authorization, Call Center, IT) and Pharmaceutical Benefits Manager (PBM) shadow audits.
Supplemental support for Grievance; Appeals; Member Services; Sales; Provider Relations; Credentialing.
Develops, implements, and maintains performance monitoring metrics and reporting mechanisms to ensure compliance with corporate Medicare contracts.
Works collaboratively with team from Medicare lines of business (LOB) and work teams.
Ensures that all sponsored/affiliate plans are in compliance with Medicare Program regulatory requirements.
Performs on-going regulatory analysis of CMS regulations; ensures Medicare regulations are interpreted and operational procedures are put into place and communicated to the LOB.
Coordinates and organizes CMS site visits to corporate office; prepares for and reports on routine and focused CMS audits for health plan Affiliates, (on first tier, downstream, providers, contractors, and subcontractors); assists in coordination of PBM audits and data compilation.
Builds effective working relationships and serves as technical advisor with interdepartmental and Affiliate plans’ service lines.
Supports applicable operational departments by providing initial and ongoing training on Medicare Advantage, both enterprise and for health plan Affiliates.
Assists with enrollee material document development primarily through the use of model materials.
Coordinates all activities associated with marketing material submissions and enrollee documents and maintains tracking log for all plans for CMS approval.
Ensures, as needed, effective execution of corrective action requirements imposed by CMS for Medicare contract deficiencies.

ABOUT SCHALLER ANDERSON:

Schaller Anderson administers Medicaid and employer self-funded health plans, and manages behavioral health plans. The company’s suite of services includes member services; provider services; claims processing; information services; financial reporting and analysis; medical management; and grievances and appeals services. Schaller Anderson has also been engaged in several consulting projects for states, health plans and providers. Schaller Anderson and its affiliates have 1,400+ employees nationwide and administer health plans with over 1.6 million members. Recently, the Initiative for a Competitive Inner City and Inc. magazine named Schaller Anderson to the Inner City 100, a list that recognizes the fastest-growing companies in America’s core urban areas. Schaller Anderson placed eighth among 5,000 entries in the Inner City 100 competition and was the only health care management company in the top 10.

The VISION of Schaller Anderson, Inc. is to be recognized as the nation’s foremost managed care resource by providing the highest value management and consulting services throughout the health care continuum.


BENEFITS:

Schaller Anderson team members are provided with countless opportunities to make a real difference and the following compensation/benefits:

* Competitive compensation DOE
* Medical, Dental and Vision insurance
* Employee Assistance Program
* Flexible spending accounts
* On-site fitness center (Phoenix headquarters only)
* Life insurance and accidental death and dismemberment insurance
* Short-term and long-term disability
* Paid holidays, paid time off/paid time off reserve
* 401(k) and profit sharing
* Tuition reimbursement
REQUIREMENTS
Knowledge and Skills:
Prefer experience or training as an Auditor
Effective organization skills
Knowledge of applicable legislation/regulations (i.e., Medicare Advantage and Part D, extensive knowledge of CMS Rules and Regulations preferred)
Understanding of third party payment rule
The ability to work independently and without close supervision
Effective written and oral communications and presentation skills
Ability to present effectively highly complex information and respond to questions from department managers and other internal clients
Creative, collaborative, structured thinker and action-taker; demonstrable problem solving skills; effective business judgment
Proficiency in the use of MicroSoft Office Suite applications, including Word, Excel, PowerPoint and Access

Education and Work Experience:
Bachelor degree in closely related field (preferably in business, healthcare management or similar discipline) is preferred, although an equivalent combination of formal education and recent and related experience (minimum of 3 years of relevant experience in state or federal compliance/regulatory or managed care industry) may substitute for a degree. Previous related experience in consulting/independent contractor-level role with increasing responsibilities for multi-faceted direction and planning desirable.