Note: The job is a remote job and is open to candidates in USA. Central California Alliance for Health is a regional non-profit health plan committed to providing accessible, quality health care. They are seeking a Medicare Membership & Eligibility Analyst to support Medicare operations through data analysis and compliance with regulations.

Responsibilities

• Supports Medicare operations, sales, and enrollment functions through analysis and interpretation of Medicare and Medi-Cal data and ensures compliance with applicable state and federal regulations
• Conducts complex research and analysis in support of Medicare Operations activities
• Acts as a subject matter expert and liaison to internal and external stakeholders

Skills

• Knowledge of CMS guidelines related to Medicare sales and enrollment
• Knowledge of Medicare Advantage enrollment processes and financial reconciliation
• Knowledge of contents and interpretation of monthly membership reports
• Knowledge of research, analysis, and reporting methods
• Knowledge of data analysis tools, CRM/enrollment systems, and the use of databases
• Ability to analyze complex data sets and present actionable insights
• Ability to identify issues, gather and analyze information and data, reach logical and sound conclusions, and make recommendations for action
• Ability to interpret, explain and apply applicable policies, laws, codes, regulations, and contracts
• Ability to organize work, manage multiple projects, establish priorities, adjust to changing priorities, and meet deadlines
• Ability to assist with the development and implementation of projects, systems, programs, policies, and procedures
• Ability to develop and implement operational workflows
• Bachelor's degree in Business Administration, Health Care Administration, Public Health, or a related field
• Minimum of five years of progressively responsible experience related to Medicare membership operations and/or enrollment eligibility
• Master's degree may substitute for two years of the required experience; or an equivalent combination of education and experience may be qualifying

Benefits

• Medical, Dental and Vision Plans
• Ample Paid Time Off
• 12 Paid Holidays per year
• 401(a) Retirement Plan
• 457 Deferred Compensation Plan
• Robust Health and Wellness Program
• Onsite EV Charging Stations

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