Manager, Government Contracts-Medicare
Responsible for day-to-day oversight, monitoring, and management of CMS Part C, Part D, and SNP contractual requirements. Responsible for oversight and ensuring timely submission of required Part C, Part D, and SNP reporting, including SNP Structure and Process Measure reporting. Primary internal contact for informational requests and contract interpretations.
Monitors daily activities to ensure contractual compliances with regard to Part C, Part D, and SNP requirements. Generates and/or distributes regular reports and summary narratives – Queue Statistics, Representative Statistics, Scorecards. Works with functional area owners to develop action plans for missed/at risk metrics. Communicates status in weekly management meetings, escalates risk areas as appropriate. Examples are listed below:
- Daily and Monthly Reports for Phone Queues
- Weekly and monthly Claim KPI summaries
- Quarterly summaries of network adequacy activities
- Daily and Monthly Reports for Member Services Representatives
- Reports for Member Services Representatives as requested by Supervisors
- Scorecards for Satisfaction Committee
- Building and Maintaining databases and reports
- Working with Quality Auditor to maintain scorecards of audit scores.
- Pull and assess reports for phone queues
- Pulling information for Member Services Survey and importing information for Member Services Survey Database
- Back-up liason with CMS Regional Office staff
- Develops responses to CMS or state agencies as required for Medicare product lines
- Membership Accounting timelines and Quality reports
- Research for internal departments, interpretation and communication of CMS position/regulations as requested.
- Implements changes to contract as defined through CMS notices. Develops, maintains and updates regulatory workplans, including CMS managed Care Manual and Prescription Drug Benefit Manual updates and HPMS memos
- Assigns responsibility for actions, tracks and works with functional areas as needed.
- Facilitate collection and submission of documentation for internal and CMS audits.
- Assist with policy and procedure updates/tracking
- Other duties as assigned.