MetroPlusHealth provides the highest quality healthcare services to residents of Bronx, Brooklyn, Manhattan, Queens and Staten Island through a comprehensive list of products, including, but not limited to, New York State Medicaid Managed Care, Medicare, Child Health Plus, Exchange, Partnership in Care, MetroPlus Gold, Essential Plan, etc. As a wholly-owned subsidiary of NYC Health + Hospitals, the largest public health system in the United States, MetroPlusHealth's network includes over 27,000 primary care providers, specialists and participating clinics. For more than 30 years, MetroPlusHealth has been committed to building strong relationships with its members and providers to enable New Yorkers to live their healthiest life.Position OverviewReporting to the Senior Manager of Medicare Operations, the Product Specialist, Integrated Products will play a critical role in supporting product excellence, implementation, and regulatory compliance for the Integrated Medicare lines of business. The position will provide analytical support and project management to the Senior Manager of Medicare Operations to ensure timely and accurate compliance and execution of Medicare projects.
Job Description- Support the Senior Manager of Medicare in providing oversight of Integrated Plans and vendor operations, aligning outcomes to strategic goals & regulatory requirements.
- Support the development & management of product dashboards to track product and branding effectiveness.
- Analyze and trend data to provide insights to the Senior Manager of Medicare Operations & management on Integrated Products operations including but not limited to membership, benefits, market trends & position, claims and oversight.
- Provide project management support to ensure projects are completed on time & meet the needs of the organization including but not limited to Integrated Products implementation and coordination of CMS model materials.
- Responsible for Integrated Product performance improvement initiatives and identifying issues & resolutions.
- Provide updates resulting from regulatory changes, new product/program implementations, special projects.
- Proactively identify & escalate gaps, making recommendations to enhance current processes.
- Serve as a liaison between multiple stakeholders to ensure clear, consistent communications & that cross functional solutions meet product requirements.
- Support operational departments in developing workflows, issue logs, project plans as needed to meet product requirements.
- Assist in the development of policies and procedures, and other product specific documentation.
- Partner with operational departments to research and identify root cause issues and evaluate solutions related to product.
- Respond to all internal and external requests for data, information and statistics related to regulatory and product reporting activities.
- Support additional duties and projects based on business needs such as CMS and State Audits, AEP, Readiness Activity, Timeliness Monitoring Project, and Medicare Data Validation.
- Analyze, identify, and investigate root causes as issues are raised to the team.
- Develop project plans and timelines for stakeholders with minimal supervision.
- Other duties as required.
Minimum Qualifications- Bachelor's degree from an accredited college or university in an appropriate discipline required.
- Minimum 4 years of experience in Medicare Managed Care, preferably with a Health Plan, in a compliance/regulatory/legal/product/operations or project management role.
- Minimum 1 year of experience managing complex projects, including complex product development processes.
- Experience in developing and monitoring operational dashboards and KPI's to ensure operational effectiveness.
- Demonstrated ability in managing workplans and holding stakeholders accountable.
- Demonstrated ability in managing multiple deliverables simultaneously and meet compliance timelines.
- Experience in managing projects and partnering with cross-functional teams.
- Excellent analytical skills as demonstrated by significant ability to pull data, analyze complex data sets, and present in consumable reports/presentations to management.
- Facility with MS Office including Excel/Access/Visio required.
- Experience using reporting tools & software such as SQL, SAS, Tableau preferred.
Professional Competencies
- Results-driven
- Systems orientation
- Process improvement
- Technical & analytical skills
- Customer focus
- Excellent verbal and written communication skills
- Resourcefulness
- Critical thinker
- Motivated self-starter
- Ability to work effectively and with minimal supervision in a fast-paced & constantly evolving environment
#LI- Hybrid