Sr. Operations and Compliance Reporting Analyst

Mass General Brigham Health Plan is an exciting place to be within the healthcare industry. As a member of Mass General Brigham, we are on the forefront of transformation with one of the world’s leading integrated healthcare systems. Together, we are providing our members with innovative solutions centered on their health needs to expand access to seamless and affordable care and coverage.

Our work centers on creating an exceptional member experience – a commitment that starts with our employees. Working with some of the most accomplished professionals in healthcare today, our employees have opportunities to learn and contribute expertise within a consciously inclusive environment where diversity is celebrated.

We are pleased to offer competitive salaries, and a benefits package with flexible work options, career growth opportunities, and much more.

Reporting to the Director of Customer Service, the Senior Operations Analyst, Compliance and Reporting will be the point person for all CMS Operations requests. This includes but is not limited to reviewing existing Operations policies, working with Operations teams to identify current gaps in procedures, implementing regulatory metric tracking, notifying Operations departments of CMS regulatory changes, and alerting leadership of cross-departmental impacts and policy and process change requirements. The ideal candidate will be comfortable working cross-departmentally with all levels of leadership as well as documenting and presenting. This person will serve as a point of contact from Operations for Compliance related inquiries and notifications.

Responsibilities:

• Ensure all Medicare Advantage policies are compliant with CMS requirements
• Ensure Operations teams are compliant on CMS related reports and audit responses
• Collaborate with Operations leadership to communicate any potential gaps in requirements.
• Work with leadership to develop and monitor metrics related to productivity.
• Represent Operations in Medicare Advantage compliance meetings.
• Document CMS regulatory updates and ensure recommend process changes.
• Monitor Vendors activities to ensure CMS metrics are met.
• Reviews and initiates opportunities for business improvement
• Confirm training materials related to Operations meet business and CMS requirements.
• Establishes and maintains effective relationships with internal stakeholders and gains their trust and respect.
• Works with Optimization manager to review call documentation
• Act as lead coordinator for CMS audits cross-departmentally within Operations.
• Work closely with the IT department to develop and monitor CMS required reports.
• Implement dashboards to enable stakeholders to see critical metrics with ease.
• Perform mock audit and test calls
• Acts as subject matter expert on Low Income Subsidy requirements across Operations including point of service, initial enrollment and annual redeeming processes.
• Inform, engage, inspire, motivate, and actively listen to employees.
• Identify/create processes and align resources to accomplish key objectives; clearly convey and assign clear accountability for important objectives, deadlines, and expectations.
• Hold self and others accountable to meet commitments.
• Ensure diversity, equity, and inclusion are integrated as a guiding principle.
• Persist in accomplishing objectives to consistently achieve results despite any obstacles and setbacks that arise.
• Build strong relationships and infrastructures that designate Mass General Brigham Health Plan as a people-first organization.
• Other duties as assigned with or without accommodation.

Qualifications:

• Bachelor’s degree required or the equivalent combination of training and experience, plus 5 years of Medicare Advantage experience.
• Experience working with all levels of leadership and implementing Operational processes.

Skills/Abilities

• Written and verbal communications
• Strong computer skills including Word, Excel, and PowerPoint
• Ability to multi-task, prioritize and work within a team setting.
• Accountable for delivering high quality work
• Demonstrate Mass General Brigham Health Plans core brand principles of always listening, challenging conventions, and providing value.
• Bring fresh ideas forward by listening to and working with employees and the people we serve.
• Respect the talent and unique contributions of every individual and treat all people in a fair and equitable manner.
• Strong, demonstrated track record of an ability to execute on time, on budget, and on scope.
• Strong aptitude for technology-based solutions.
• Ability to inject energy, when and where it’s needed.
• Current in healthcare trends.
• Demonstrated forward, visionary thinking; ability to see “what is” and envision “what could be.”
• Ability to develop, introduce, defend, and gain support for a new ideas and approaches.
• Excellent leadership skills and leadership track record.
• Ability to translate and communicate complex topics in a variety of forums, tailoring communications to effectively fit and influence the targeted audience, strong executive presence, presentation, and communication skills. Strong verbal, active listening, and written communication skills required.
• Ability to view the long-range trends and cycles of the business and industry and see the “big picture.”
• Ability to apply a variety of strategic frameworks to analyze problems and to guide and develop solutions.
• Ability to challenge the status quo and drive innovative thinking and the capability to successfully implement strategy.
• Excellent interpersonal skills, including the ability to influence others at all levels of an organization.
• Strong EQ; exercises self-awareness; monitors impact on others; is receptive to and seeks out feedback; uses self-discipline to adjust to feedback.
• Unquestionable integrity.

Diversity Statement

As a not-for-profit organization, Mass General Brigham is committed to supporting patient care, research, teaching, and service to the community. We place great value on being a diverse, equitable and inclusive organization as we aim to reflect the diversity of the patients we serve. At Mass General Brigham, we believe in equal access to quality care, employment and advancement opportunities encompassing the full spectrum of human diversity: race, gender, sexual orientation, ability, religion, ethnicity, national origin and all the other forms of human presence and expression that make us better able to provide innovative and cutting-edge healthcare and research.

EEO Statement

Mass General Brigham is an Equal Opportunity Employer. By embracing diverse skills, perspectives and ideas, we choose to lead. All qualified applicants will receive consideration for employment without regard to race, color, religious creed, national origin, sex, age, gender identity, disability, sexual orientation, military service, genetic information, and/or other status protected under law. We will ensure that all individuals with a disability are provided a reasonable accommodation to participate in the job application or interview process, to perform essential job functions, and to receive other benefits and privileges of employment.

Disclaimer

The above statements are intended to describe the general nature and complexity of the work being performed by personnel assigned to this classification and do not represent an exhaustive list of all tasks, duties, and responsibilities required of personnel assigned to this position.