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Medicare Domain SME

Conflux Systems, Inc.

GA

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JOB DETAILS
SKILLS
Acceptance Testing, Accounting, Billing, Business Process Management, Centers for Medicare and Medicaid Services (CMS), Change Requests/Orders, Content Management Systems (CMS), Customer Relations, Detail Oriented, Documentation, Establish Priorities, Finance, Health Plan, Interpersonal Skills, Leadership, Medical Billing, Medicare, Multitasking, Operations Planning, Organizational Skills, Product Demonstration, Project/Program Management, Proposal Development, Quality Assurance Methodology, Reconciliation, Request for Proposals (RFP), Requirements Management, SQL (Structured Query Language), Test Plan/Schedule, Testing
LOCATION
GA
POSTED
30+ days ago

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.

About the Company

C

Conflux Systems, Inc.

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