Operations Analyst, Government Programs (EGWP)

Location: Hybrid (Local to NYC, Denver, CO or Charlotte, NC)

Position Summary:

The Government Programs Operations Analyst (EGWP) provides operational and administrative support to ensure day to day Health Plan activities are performed timely and compliantly.  The role will be responsible for supporting EGWP implementation and the ongoing oversight of  member touchpoint activities with the Medicare part D Prescription Drug Plan (PDP) Employer Group Waiver Plan (EGWP).  This role will perform the day to day functional activities to ensure compliance with the Centers of Medicare and Medicaid (CMS) regulations while meeting employer, member and Health Plan financial objectives.

Position Responsibilities:

• Support EGWP program setup, implementation and go-live readiness across assigned internal functions and delegate oversight, which includes enrollment, claims processing, member services, member communications, CAHPS activities and associated member service STARs activities.
• Monitor daily, weekly and monthly performance, operational KPIs and CMS compliance metrics for enrollment, member services, and member communications.
• Support with issue resolution and corrective action completion with related, first tier and downstream entities (FDRs).
• Perform oversight of monthly enrollment audits performed by CMS and semi-annual enrollment reporting.
• Perform oversight of member services and member communications through call evaluations and random sample review or materials and documentation.
• Ensure timely and accurate reporting information is received  from both internal and external resources as required by the Health plan.
• Collaborate with account management and/or employer groups on enrollment issues to be resolved by Employer groups to ensure timeliness and compliance with CMS guidance
• Develop compliant documentation for operational areas to include policies, procedures, workflows and other work instructions.
• Support additional functions, as needed.

Required Qualifications:

• Minimum of HS diploma/GED or equivalent experience
• 3+ years of Medicare Part D and/or EGWP experience
• Experience with Medicare Part D enrollment, call center and member communication requirements and reporting
• Experience working in a delegated and highly matrixed organization.
• Strong operational acumen
• Strong analytical acumen

Preferred Qualifications

• Health Plan Medicare Part D and/or EGWPs
• Experience working within CMS systems, including but not limited to HPMS and MARx.
• Experience with Federal and State Audits