This site uses cookies. To find out more, see our Cookies Policy

Senior Analyst - Regulatory Oversight in Southfield, MI at AF Group

Date Posted: 6/8/2018

Job Snapshot

Job Description

COBX- Senior Health Services





Senior Analyst -- Regulatory Oversight





SUMMARY:



Regulatory Oversight Senior Analysts are responsible for leading and/or supporting processes that ensure oversight and ongoing monitoring of Blue Cross Blue Shield of Michigan (BCBSM) Medicare Advantage and Part D programs. Interface with external customers, including regulatory agencies and professional associations, internal customers and vendors to identify and/or analyze business problems and develop solutions is required.



RESPONSIBILITIES/TASKS:




  • Ability to navigate and effectively interpret regulations and rules in accordance with the CMS Manual System and BCBSA guidelines.
  • Develop and improve work flows and business processes within process area(s) to improve controls and overall quality.
  • Assist with implementing and reviewing standard policies and procedures to ensure compliance with CMS regulations.
  • Research, analyze, and disseminate CMS guidance and communications to MA internal and external stakeholders
  • Identify, analyze, and track compliance risks and deficiencies.
  • Review corrective action plans to ensure remediation leads to effective, compliant resolution.
  • Review evidence submitted by vendors (FDR) to determine compliance with Medicare regulations.
  • Participate in development and implementation of new procedures/controls.
  • Provide recommendations for ongoing improvement of core processes.
  • Assists personnel (both internal and external) by answering questions, supplying information, and training, as appropriate.
  • Assists in the development, coordination, and implementation of methods and procedures to ensure that all sales, marketing, promotion, and operational documents and activities are compliant with CMS deadlines and regulations.
  • Writes, revises, and maintains documents related to the sale and marketing of Medicare Advantage products and submit the materials for approval through the CMS, within the mandated deadlines.
  • Facilitates CMS review of materials through research and investigation of the questions raised by and requests made by CMS.
  • Develop and maintain an effective working relationship with customers.

    This position description identifies the responsibilities and tasks typically associated with the performance of the position. Other relevant essential functions may be required.





    EMPLOYMENT QUALIFICATIONS:





    EDUCATION:



    Bachelor's degree in a related field. Relevant combination of education and experience may be considered in lieu of degree. Continuous learning, as defined by the Company's learning philosophy, is required.



    EXPERIENCE:



    Three years of experience in a related field.



    SKILLS/KNOWLEDGE/ABILITIES (SKA) REQUIRED:




  • Excellent analytical, organizational, problem solving, and verbal and written communication skills.
  • Ability to work independently, within a team environment, and with multiple priorities/deadlines.
  • Significant creativity and flexibility.
  • Ability to contribute to process improvement projects.
  • Ability to work and communicate with regulatory bodies and professional associations.
  • Proficient in current industry standard PC applications and systems (e.g., Access, Excel and Word).
  • Ability to develop, implement, and monitor policies and procedures.



    WORKING CONDITIONS:



    Work is performed in an office setting with no unusual hazards.

    The qualifications listed above are intended to represent the minimum education, experience, skills, knowledge and ability levels associated with performing the duties and responsibilities contained in this job description.

    We are an Equal Opportunity Employer. Diversity is valued and we will not tolerate discrimination or harassment in any form. Candidates for the position stated above are hired on an "at will" basis. Nothing herein is intended to create a contract.

    Equal Opportunity Employer Minorities/Women/Protected Veterans/Disabled
  • CHECK OUT OUR SIMILAR JOBS

    1. Business Analyst Jobs
    2. Business Management Jobs