Primary City/State:
Arizona, ArizonaDepartment Name:
Network DevelopmentWork Shift:
DayJob Category:
General OperationsThe future is full of possibilities. At Banner Plans & Networks, we’re changing the industry to reduce healthcare costs while keeping members in optimal health. If you’re ready to change lives, we want to hear from you.
Banner Plans & Networks (BPN) is a nationally recognized healthcare leader that integrates Medicare and private health plans. Our main goal is to reduce healthcare costs while keeping our members in optimal health. BPN is known for its innovative, collaborative, and team-oriented approach to healthcare. We offer diverse career opportunities, from entry-level to leadership positions, and extend our innovation to employment settings by including remote and hybrid opportunities.
As a Government Project Programs Associate Advisor for Banner Plans & Networks, you will call upon your coordination and relationship building strengths daily. You will conduct regular meetings with Vendors and Internal Business Owners to discuss Vendor questions, performance, and expectations. You will be part of a larger team that also manages email and telephonic inquiries.
Your work location will be entirely remote. Your work shift will be Monday-Friday following Arizona Business Hours. If this role sounds like the one for you, Apply today!
Banner Health Network (BHN) is an accountable care organization that joins Arizona's largest health care provider, Banner Health, and an extensive network of primary care and specialty physicians to provide the most comprehensive healthcare solutions for Maricopa County and parts of Pinal County. Through BHN, known nationally as an innovative leader in new health care models, insurance plans and physicians are coming together to work collaboratively to keep members in optimal health, while reducing costs.POSITION SUMMARY
This position provides technical, clerical and operational support to the Progr Mgr, Health Plans in the development, implementation, maintenance and continuous improvement of new and extant Medicare programs and projects. Provides the operational support of Medicare Programs ongoing programs. Disseminates HPMS memos, maintains files, database and documentation of project implementation and verifications, submits reports to CMS and maintains all documentation. Provides administrative support to the annual CMS Bid submission, periodic Service Area Expansions, Call letter implementation, annual readiness review attestation, etc.). Reviews submitted materials for quality, accuracy and completeness and making recommendations to Manager regarding the acceptance and/or modifications necessary for these materials. Assists with identifying, compiling and disseminating legislative and regulatory trends and initiatives that impact Medicare, Medicare Advantage and Medicare Advantage Dual SNP programs. Serves as a first line resource for navigating CMS regulations, sub-regulator guidance and policies, and is responsible for recommending and advising the functional areas and the Manager regarding impact on operations.
CORE FUNCTIONS
1. Disseminates CMS regulatory, sub-regulatory and policy guidance in a timely manner and receives verification and documentation that such guidance is strictly adhered to and implementation verified. Independently reviews evidence of implementation and advises functional areas and the Manager on the veracity of the evidence. This includes but is not limited file/administrative management of HPMS Memos, the annual Call Letter, Managed Care Manual Chapter changes and updates, the annual readiness checklist.
2. Assists with the annual CMS Bid process. Performs independent QA of the submission and advises Manager on the results with recommendations of corrections as appropriate.
3. Provides technical and operational support and processing of the annual Service Area Expansion process as necessary. Performs independent QA of the submission and advises Manager on the results with recommendations of corrections as appropriate.
4. Submits or monitors all required materials and data to CMS via HPMS. Collects materials from the functional area (in which case the Manager will facilitate and verify) and assists as necessary. Performs independent QA of the submission and advises Manager on the results with recommendations of corrections as appropriate. This includes but is not limited to formulary submission, annual website update, marketing materials, LIS match Rates, Monthly Encounter Data (formerly RAPS), Part C and Part D Reporting.
5. Provides support for the following: the development of the New Member Notifications (e.g. ANOC, EOC), development and production of all member materials, maintenance of most current model member communications, attends all relevant CMS user group calls, project management of the annual Data Validation process.
6. Serves as resource for Annual 5 Star plan. Compiles and disseminates legislative and regulatory trends and initiatives that impact Medicare, Medicare Advantage and Medicare Advantage Dual SNP programs. Assists with project management and monitoring of Model of Care requirements and processes.
7. Assists with the production of Monthly Operational Dashboard (actual production of data comprising dashboard is the responsibility of the functional areas). Assists with ensuring functional areas are compiling and reporting the data that comprise the Monthly Medicare Compliance Dashboard.
8. Assists with the annual Medicare Product implementation workgroup.
9. This position works under supervision, prioritizing data from multiple sources to provide quality care and support. Incumbents work in a fast-paced, sometimes stressful environment with a strong focus on customer service. Interacts with staff at all levels throughout the organization.
MINIMUM QUALIFICATIONS
Knowledge, skills and abilities as normally obtained through the completion of a bachelor’s degree and one year experience working in an office environment.
Knowledge of record management best practices, project coordination and database development and maintenance and knowledge of Medicare and Medicaid managed care practices and regulations.
Skill in communicating with all levels of the organization, oral and written communication skills, and skill in building and maintaining interpersonal relationships. Skill in the use of computer applications including Microsoft office products and EXCEL. Ability to organize and execute programs, work independently ensuring all deadlines are met. Ability to be flexible in order to work on a variety of initiatives simultaneously under tight time constraints and to work cross functionally across the organization and to use critical thinking in resolving problems and conflicts. Ability to grasp new knowledge and concepts quickly and apply them
PREFERRED QUALIFICATIONS
One to two years of experience of health care administrative support experience, one to two years of other administrative support experience, one year of project coordination/project management experience preferred.
Additional related education and/or experience preferred.
EEO Statement:
EEO/Female/Minority/Disability/Veterans
Our organization supports a drug-free work environment.
Privacy Policy:
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