Cms Expert Jobs (NOW HIRING)

Process Expert II

Location: Hybrid1: This role requires associates be in the office 1-2 days per week, fostering collaboration and connectivity, while providing flexibility to support productivity and work-life balance. This approach combines structured office engagement with the autonomy of virtual work, promoting a dynamic and adaptable workplace. Alternate locations may be considered.

*Please note that per our policy on hybrid/virtual work, candidates not within a reasonable commuting distance from the posting location(s) will not be considered for employment, unless an accommodation is granted as required by law.

The Process Expert II supports a single operations department by participating in project and process work. This employee will be an expert in COB guidelines, including NAIC regulations and Medicare Secondary Payer Rules, applicable across all business lines.

How you will make an impact:

• Researches operations workflow problems and system irregularities
• Proficient in developing, exploring, and executing SQL queries on complex COB concepts, utilizing extensive experience with data insights and auditing techniques.
• Skilled in conducting thorough investigation research and engaging in necessary outreach (e.g., OHI, CMS, employers, ESRs) to ensure accurate validation of primacy and eligibility updates.
• Develops tests, presents process improvement solutions for new systems.
• New accounts and other operational improvements; develops and leads project plans and communicates project status.

Minimum Requirements:

• Requires a BA/BS and minimum of 5 years experience in business analysis, process improvement, project coordination in a high-volume managed care operation (claims, customer service, enrollment and billing); or any combination of education and experience, which would provide an equivalent background.

Preferred Skills, Capabilities, and Experiences:

• 5-7 years of comprehensive experience in COB auditing, covering both CB and GB concepts.
• Expert in COB guidelines, including NAIC regulations and Medicare Secondary Payer Rules, applicable across all business lines.
• Adept at researching and analyzing data gaps and system inconsistencies to enhance efficiency and capture savings opportunities through prevention and recoveries.
• Capable of identifying innovative ideas, approaches, and processes to optimize savings and operational efficiency.
• Consistently uphold high standards of quality assurance.
• Strong analytical and problem-solving abilities.
• Support user acceptance testing and contribute to data validation and reporting analysis.
• Proficient in data validation and reporting analysis.
• Ability to analyze workflows, processes, supporting systems and procedures and identifying improvements strongly preferred.

For URAC accredited areas, the following professional competencies apply: Associates in this role are expected to have strong oral, written and interpersonal communication skills, problem-solving skills, facilitation skills, and analytical skills.

Please be advised that Elevance Health only accepts resumes for compensation from agencies that have a signed agreement with Elevance Health. Any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of Elevance Health.

Who We Are

Elevance Health is a health company dedicated to improving lives and communities - and making healthcare simpler. We are a Fortune 25 company with a longstanding history in the healthcare industry, looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve.

How We Work

At Elevance Health, we are creating a culture that is designed to advance our strategy but will also lead to personal and professional growth for our associates. Our values and behaviors are the root of our culture. They are how we achieve our strategy, power our business outcomes and drive our shared success - for our consumers, our associates, our communities and our business.

We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few.

Elevance Health operates in a Hybrid Workforce Strategy. Unless specified as primarily virtual by the hiring manager, associates are required to work at an Elevance Health location at least once per week, and potentially several times per week. Specific requirements and expectations for time onsite will be discussed as part of the hiring process.

The health of our associates and communities is a top priority for Elevance Health. We require all new candidates in certain patient/member-facing roles to become vaccinated against COVID-19 and Influenza. If you are not vaccinated, your offer will be rescinded unless you provide an acceptable explanation. Elevance Health will also follow all relevant federal, state and local laws.

Elevance Health is an Equal Employment Opportunity employer and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, or local laws. Applicants who require accommodation to participate in the job application process should submit the Accessibility Accommodation Request Form and a member of the team will be in contact.

Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state, and local laws, including, but not limited to, the Los Angeles County Fair Chance Ordinance and the California Fair Chance Act.

Prospective employees required to be screened under Florida law should review the education and awareness resources at HB531 | Florida Agency for Health Care Administration.