Medicare Domain SME

Title: Medicare Domain SME

Location: Jefferson City MO, USA - Remote

MUST HAVE:

• Medicare SME
• Medicare Advantage
• Enrolment
• Premium Billing
• CMS Guidelines
• Capitation Revenue reconciliation
• Member correspondence
• Medicare operations workflow

This Expert must be able to play a leadership role in managing and coordinating the members of the BIA team. They must have excellent interpersonal skills, be self-reliant and generate confidence to the extent that they can take increasing levels of personal responsibility in relation to delivering solutions directly to the client. They will be required to undertake project management duties and lead work streams, participate in RFP responses, change request proposal development, provide product demonstration and Perform user acceptance testing.

Experience and Education Requirements

• BA/BS degree in business/accounting/finance or equivalent experience.
• Thorough experience of Medicare Advantage health plan operations around Eligibility and Enrolment, CMS guidelines, Member correspondence, Medicare operations workflow, Premium billing, and Capitation Revenue reconciliation
• 10+ years experience with customer relations activities, including business process management, issue management, ability to define desired outcomes, and solutions.
• 10+ years experience documenting requirements gathering sessions, processes, procedures, user manuals, and outcomes.
• 10+ year experience developing test criteria and executing the test process.
• Should have hands on experience writing basic SQL queries.
• Excellent organizational skills and attention to detail, with the ability to multi-task and prioritize.

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