Job Details

260+ Day Contract

Hybrid - i day in office/Detroit

Top 3 Required Skills/Experience –
• CMS Knowledge
• Data Reconciliation and file management
• Good Communication

Required Skills/Experience – The rest of the required skills/experience.  Include:  
Medicare Advantage Enrollment Expertise:
1. Minimum 2-4 years of direct experience with Medicare Advantage Enrollment processes
2. Experience with CMS MAPD, MA and PDP standalone enrollment/disenrollment regulations, enrollment mechanisms, Late Enrollment Penalty (LEP) and Low-Income Subsidy (LIS),  Plan Communication User Guide
Data Reconciliation and File Management:
1. Experience with monthly/weekly membership reconciliation
2. Experience with monthly CMS membership reconciliation (MARx, TRR).
3. Ability to analyze discrepancies, manage large datasets and track resolution through internal reporting tools.
4. Knowledge of CMS thresholds and compliance timelines for discrepancy resolution.
5. Understanding of required documentation and timelines for retroactive processing and case development.
Operational Process Improvement:
1. Ability to identify operational gaps, define root causes, and implement process improvements
Regulatory Compliance and Audit Support:
1. Experience supporting internal and CMS program audits and Compliance reporting.
Technical and Reporting Skills:
1. Intermediate experience of Microsoft Programs with Excel (Pivot tables), Word, Outlook, OneNote
Communication and Knowledge Dissemination:
1. Effective written and verbal communication skills