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Supervisor EBS (Medicare Advantage Enrollment & Reimbursement)

Company: Blue Cross of Idaho
Location: Meridian
Posted on: May 14, 2019

Job Description:

Position Description

To establish and supervise work processes and training programs that are compliant with all applicable Federal and State regulations for Medicare Advantage (MA), Med Plus and MMCP enrollment processing and reimbursement reconciliation. Identify deficiencies in the department through development of performance and quality assurance programs, improving quality of data entry and Center for Medicaid/Medicare Services (CMS) acceptance rate and contributing to the plan's desired Medicare Star measures. Develop compliant member written communications and make final decisions regarding eligibility, election period and enrollment-related grievances.

Position Requirements

QUALIFICATIONS: (Minimum qualifications required for the job)


  • Two years' enrollment & billing experience within health insurance industry, managing or supervising personnel
  • Two year's Medicare Advantage experience

    Knowledge, Skills and Abilities (KSAs):

    • Microsoft Office (Word, Excel) - Intermediate
    • Strong Written and verbal communication
    • Proven leadership capabilities
    • Documentation and audit
    • Performance metrics analysis

      Ability to:
      • Assess regulatory guidance and translate into workflows, member communications and departmental policies, procedures, training and reports
      • Develop expertise in a variety of concepts, practices and procedures
      • Interpret large data sets for workflow and process deficiencies and take corrective action
      • Work collaboratively across business functions and meet critical deadlines
      • Effectively monitor & maintain department and staff performance levels

        Preferred Qualifications:
        • Bachelor's degree
        • Supervisory experience
        • Experience in a Medicare Advantage program
        • Experience with EAM, Facets and with CMS systems including MARx, Online Enrollment Center (OEC) and Health Plan Maintenance System (HPMS)
        • Knowledge of applicable CMS and State regulations and guidance manuals
        • Demonstrated high performance and quality results

          Position Reports to: Manager, EBS
          Internal Job Posting: 5/8/2019 - 5/15/2019
          External Job Posting: 5/9/2019 - Until Filled

          We are an Equal Opportunity Employer and do not discriminate against any employee or applicant for employment because of race, color, sex, age, national origin, religion, sexual orientation, gender identity, status as a veteran, and basis of disability or any other federal, state or local protected class.

Keywords: Blue Cross of Idaho, Meridian , Supervisor EBS (Medicare Advantage Enrollment & Reimbursement), Other , Meridian, Idaho

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