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Director Medicare Operations Jobs in Indiana (NOW HIRING)

... Director of Medicare and team with ongoing and specialized data projects, often involving cross ... Identify process improvements and contribute to enhancing operational workflows across the Medicare ...

... Medicare Advantage organizations, and provider partners including hospitals and PCP networks and ... US Oncology operations, Onmark operations, GPO, Pharmacy Solutions, Oncology Intelligence ...

Managed Care Director

Dyer, IN · On-site

$90 - $120/hr

... Medicare Advantage organizations, and provider partners including hospitals and PCP networks and ... Works with assigned practices and McKesson operations, finance, Managed Care team and the pharmacy ...

... Medicare Advantage organizations, and provider partners including hospitals and PCP networks and ... US Oncology operations, Onmark operations, GPO, Pharmacy Solutions, Oncology Intelligence ...

Knowledge of business management and a working knowledge of the Medicare Hospice Benefit preferred ... operational excellence and employee development. * Must have an outstanding interpersonal ...

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Director Medicare Operations information

What does a director Medicare Operations do?

A Director of Medicare Operations is responsible for overseeing the administration and management of Medicare-related programs within a healthcare organization or insurance company. This role involves ensuring compliance with federal and state regulations, optimizing operational efficiency, and leading teams that handle enrollment, claims processing, and customer service for Medicare members. The director also collaborates with other departments to implement strategic initiatives, improve quality of care, and ensure financial performance. Their leadership helps ensure that Medicare beneficiaries receive timely and accurate services while maintaining the organization's standards and objectives.

What are the key skills and qualifications needed to thrive as a director Medicare Operations?

To thrive as a Director of Medicare Operations, you need deep knowledge of Medicare regulations, healthcare administration, and operational leadership, often supported by a bachelor's or master's degree in healthcare or business. Familiarity with claims processing systems, CMS guidelines, and data analytics tools is typically required. Strong strategic thinking, problem-solving, and communication skills are essential for leading teams and ensuring regulatory compliance. These skills and qualities are vital for optimizing operational efficiency, maintaining compliance, and driving organizational success in the complex Medicare landscape.

How does a director Medicare Operations typically collaborate with compliance and clinical teams to ensure regulatory adherence?

A Director of Medicare Operations plays a critical role in bridging operational processes with compliance and clinical teams. They regularly coordinate with compliance officers to interpret and implement CMS regulations, ensuring all processes meet federal standards. Additionally, they work closely with clinical leaders to design workflows that maintain both operational efficiency and high-quality patient care. This collaboration often involves frequent meetings, joint audits, and developing cross-functional training to address any regulatory or quality issues promptly.

What are the most commonly searched types of Medicare Operations jobs in Indiana?

The most popular types of Medicare Operations jobs in Indiana are:

What are popular job titles related to Director Medicare Operations jobs in Indiana?

For Director Medicare Operations jobs in Indiana, the most frequently searched job titles are:

What cities in Indiana are hiring for Director Medicare Operations jobs?

Cities in Indiana with the most Director Medicare Operations job openings:

Medicare Specialist

Indianapolis, IN • On-site

Shepherd Insurance
Insurance Services • 201 - 500 employees

Full-time

Re-posted 23 days ago


Job description

PURPOSE:
This is an ideal opportunity to work at a growing organization with a strong family culture. Shepherd Insurance is a privately-owned insurance agency that has delivered risk management solutions since 1977. With a wide variety of insurance and financial products, we are among the largest independent agencies in the country.
As a Medicare Specialist within the Shepherd family, you will serve as a knowledgeable support partner to the Licensed Agents - Medicare Insurance Division and team by executing specialized operational functions, ensuring compliance accuracy, enhancing workflow efficiency, and support the client and agent experience. With a positive attitude, you will provide strong attention to detail and the ability to navigate Medicare and carrier systems with accuracy and efficiency.
ROLES AND RESPONSIBILITIES
  • Mange the intake, organization and closing of Medicare-related data with a strong focus on accuracy and compliance.
  • Oversee policy renewal processing with AgencyBloc system, ensuring data integrity and timely completion.
  • Coordinate and prepare pre-appointment documentation, including Scope of Appointment forms and Client Intake Sheets, ensuring readiness for agent consultations.
  • Maintain and audit required sales documentation to ensure adherence to CMS and carrier guidelines.
  • Navigate Medicare and carrier portals to perform provider searches, formulary and drug cost assessments, and benefit verification at a specialist level.
  • Assist the Director of Medicare and team with ongoing and specialized data projects, often involving cross-system information gathering, cleanup and reporting.
  • Identify process improvements and contribute to enhancing operational workflows across the Medicare division.
  • Perform other related duties as assigned.

Requirements
  • Complete annual training for General Compliance and Fraud/Waste/Abuse.
  • Familiar with a variety of computer software applications including Microsoft Office products (Word, Excel, Outlook, PowerPoint).
  • Ability to work independently, manage multiple priorities, and adapt quickly to directional changes within the Medicare division.
  • Strong organizational skills, attention to detail and commitment to confidentiality.

EDUCATION AND EXPERIENCE REQUIREMENTS
  • Education requirement: High school diploma or equivalent (GED) is required. College degree is preferred, not necessary.
  • Experience: At least two (2) years' experience in similar position is desirable.

WORKING CONDITIONS/PHYSICAL DEMANDS
Work environment characteristics and physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
While performing the duties of this job, the employee is occasionally required to stand; walk; sit; use hands to finger, handle, or feel objects, tools or controls; reach with hands and arms; climb stairs; balance; stoop, kneel, crouch or crawl; talk or hear; taste or smell. The employee must occasionally lift and/or move up to 25 pounds. Specific vision abilities required by the job include close vision, distance vision, color vision, peripheral vision, depth perception, and the ability to adjust focus. While performing the duties of this job, the employee is not exposed to weather conditions. The noise level in the work environment is usually moderate