Additional Information
We are recruiting for a mission-driven Commercial Products Analyst I - Denver Health Medical Plan (* Weekly Hybrid Schedule Requirement *) to join our team!
We're with you for life's journey. At Denver Health, purpose isn't just something we believe in-it's something we live every day, for life's journey.
Our Values
Respect | Belonging | Accountability | Transparency
Department
Managed Care Administration
* This is a hybrid role with a weekly in-office requirement.
Job Summary
Assists the Commercial Products team with the maintenance and administration of the Denver Health Medical Plan, Inc. (DHMP) Exchange, including CO Option, and Employer Group products. This position will ensure compliance with all State and Federal-level regulatory requirements requiring strong attention to detail and the ability to independently research, interpret and apply regulatory guidance. Standard work also includes creating analyses and reports, assisting with project and implementation plans, developing marketing materials and providing input on policies and procedures for departmental activities. This position will routinely utilize multiple systems and data sources to complete work timely and accurately, as well as interact with all levels of management and employees, plan members, external consultants, and State and Federal representatives.
Essential Functions :
Reviews all State and Federal regulations and policy changes, conducting independent research to understand regulatory intent and operational impact; then communicates and collaborates with program areas to support implementation. Supports in analysis and coordination of internal and regulatory audits and regulatory materials (handbooks, benefit information) and communications. Supports member experience through attending events and partnering with the Marketing team to ensure aligned messaging to educate and retain members. (30%)
Works independently, with Commercial Products team and other Managed Care Departments, serving as liaison to interpret contractual or regulatory requirements, leading the effort to improve workflows, policies and procedures. Creates and compiles accurate and vetted reports, attestations and other submissions to the State and CMS. Sustains collaborative relationships and promotes meaningful dialogue with regulatory bodies, internal teams and community partners. (30%)
Researches and resolves member and provider escalations, requiring familiarity with Commercial health insurance benefits and ACA/Exchange products (20%)
Assists in setting strategic direction of projects, developing project plans, analytic support services and applicable technical/subject matter expertise to achieve organizational goals. (20%)
Education :
Bachelor's degree required
Work Experience :
Less than 1 year of health care/plan experience with a preferred emphasis on Commercial health plan operations, regulatory issues, policy development or compliance required
Licenses :
Knowledge, Skills and Abilities :
Substantial knowledge of managed care/health care administration, policy and compliance, particularly regarding Commercial health plan operations
Ability to interpret and synthesize Federal and State regulatory requirements
Proficiency in Microsoft Excel, including pivot tables, VLOOKUP, and other functions to analyze, reconcile and validate datasets
Self-starter who works with limited supervision and guidance, demonstrating strong organizational skills and attention to detail
Ability to define problems, collect data, establish facts and draw valid conclusions to implement solutions and ability to develop data requirements and work with operations teams and groups to extract, organize and analyze data and trends
Critical thinking, strong written and verbal communication skills, and the ability to work collaboratively in groups
Ability to work on multifaceted projects in conjunction with day-to-day activities
Critical thinking, strong written and verbal communication skills, and the ability to work collaboratively in groups
Shift
Days (United States of America)
Work Type
Regular
Salary
$59,400.00 - $86,100.00 / yr
Denverhealth · Denver