Elevance Health Director I Medicare Operations
Location: This position will work a hybrid model (remote and office). The ideal candidate will live within 50 miles of one of our PulsePoint locations.
National Government Services is a proud member of Elevance Health's family of brands. We administer government contracts for Medicare and partner with the Centers for Medicare and Medicaid Services to transform federal health programs.
The Director I Medicare Operations is responsible for directing multiple business function operations teams on Tier I contract with primary responsibility for Program Management and/or Medicare Integrity Operations.
How you will make an impact:
- Responsible for directing multiple business function operations teams on Tier I contract with primary responsibility for Program Management and/or Medicare Integrity Operations.
- Program Management includes but is not limited to: Claims, Grievance & Appeals, Administrative Law Judge (ALJ) appeals, Written Inquiries, Overpayment Recoveries, and Medicare Secondary Payer.
- Medicare Integrity Operations includes but is not limited to: Medical Policy/Review, Provider Outreach and Education, data mining & reporting, and identifying opportunities for improvement.
- Responsible for Quality Assurance, response to Internal Audit results, Workforce Management and ensuring compliance with Federal laws and regulations.
- Directs the daily activities of the Quality Review staff in performing reviews of operational quality issues.
- Manages performance compliance to determine adequacy of internal controls and identifies workflow efficiencies.
- Ensures deficiencies in compliance are identified and recommendations are prepared to strengthen the control environment.
- Drives innovation throughout the assigned business function areas to reduce costs associated with performing CMS statement of Work requirements.
- Strong Financial Acumen; ability to manage department financials including annual forecasting and monthly oversight.
- Ability to develop a 2-3 year operational strategy plan and manage oversight of plans.
- Has frequent contact with various representatives of CMS and peer contractor staff.
- Hires, trains, coaches, counsels, and evaluates performance of direct reports.
- Travels to worksite and other locations as necessary.
Minimum Requirements:
Requires a BA/BS in a related field and minimum of 7 years professional/leadership experience with CMS, including strategic planning, project management, Medicare or related healthcare insurance or medical policy field, minimum of 3 years management experience.
Preferred Skills, Capabilities, and Experience:
- Understanding of technology and ability to partner with IT to create a roadmap for enhancements and automation.
- Experience with managing operational workloads, productivity and planning forecasts.
- Understanding of the Agile PI Planning Process.
- Innovation and Change mindset; must have experience managing associates through change.
For candidates working in person or remotely, the salary range for this specific position is $117,200 to $210,960.
In addition to your salary, Elevance Health offers benefits such as a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution.
Elevance Health is a health company dedicated to improving lives and communities – and making healthcare simpler. We are a Fortune 25 company looking for leaders who are passionate about making an impact.
Elevance Health is an Equal Employment Opportunity employer and all qualified applicants will receive consideration for employment without regard to any protected status.
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