The Manager of Medicare Product Management supports the continuous improvement of BMCHP-WellSense’s Medicare product portfolio through the oversight and management of the product operations of Medicare benefits. This role serves as subject matter expert regarding Medicare Advantage product operations and Chapter 21 of the Medicare Managed Care Manual. Responsibilities include benefit vendor and regulatory oversight, benefit implementation, compliance reporting, internal and external audit support, identifying and resolving escalated issues and developing insight-driven reports for Product Leadership. This role will also support cross-functional areas to ensure vendors are compliant with applicable privacy, security, business continuity and compliance requirements through annual evaluations, risk assessments and monitoring of remediations. Successful candidates will have the ability to interpret findings, and communicate insights and recommendations to Product Management leadership.
KEY FUNCTIONS/RESPONSIBILITIES:
- Develop, implement and oversee the vendor oversight process for the Medicare Advantage Product department benefits, complying with all applicable federal and state laws and regulations.
- Monitors vendors performance to ensure all SLAs and KPIs are contractualyl met.
- Support the strategic product development, management and execution of comprehensive strategy plans for all Medicare product lines.
- Manage First-Tier, Downstream and Related Entities (FDR) vendors while ensuring Centers for Medicare & Medicaid Services (CMS) regulatory requirements are met.
- Oversee the day-to-day management of the Medicare vendors by utilizing data, metrics, and market feedback to provide recommendations to Product Management leadership that will enable product or program enhancements and strategic decision making.
- Act as the interface between vendors and BMCHP-WellSense, including keepings vendors informed on developments within the organization or changes in the Medicare market that might affect the demand for vendors’ product or services.
- Develop a FDR assessment tool to aid in risk mitigation, increase efficiency and strengthen relationships.
- Drive contract changes and amendments by clearly defining scope, responsibilities, schedules and service level agreements in accordance with CMS regulations and guidelines.
- Participate in internal and CMS audits, such as ODAG and CPE in addition to performing post audit activities involving follow-up with vendors to ensure compliance effectiveness.
- Responsible for the Medicare Advantage reporting elements of Centers for Medicare & Medicaid Services.
- Maintain a comprehensive understanding of the regulatory environment and market changes that impact vendor partners.
- Perform audit assessments, continuous monthly and quarterly reviews, and ongoing monitoring activities to ensure compliance. Provide monthly reporting to our internal compliance department documenting adherence and/or any findings.
- Create departmental policies and procedures derived from CMS guidance.
QUALIFICATIONS:
EDUCATION:
- A Bachelor’s Degree in a related field such as business or healthcare.
EDUCATION PREFERRED:
- MBA or other graduate degree preferred.
EXPERIENCE:
- 5+ years experience in government regulatory products
- A background in managed healthcare, insurance operations preferred
- Medicare Advantage experience preferred
- Strong problem solving skills with an emphasis on product management
- Excellent written and verbal communication skills
- Solid organizational skills including attention to detail and multitasking skills
- Strong working knowledge of Microsoft Office
Required Skills
Required Experience