Health Care that Starts with You!
Join a truly mission-driven organization! Independent, nonprofit UCare is recognized as one of the Minnesota's leading health plans. We provide more than 600,000 members across Minnesota and western Wisconsin with the health coverage plans and services they need to maintain and improve their health. The innovative coverage we create makes a difference for Medicare-eligible individuals, individuals and families enrolled in Minnesota Health Care Programs, such as MinnesotaCare and Medical Assistance, and disabled adults with special health care needs.
UCare is growing in size, membership, products, geographic coverage, and employees. We're an organization that's going places. Be part of a team that cares about you, be part of UCare.
Enter a highly collaborative environment where people are truly engaged, and feedback is valued. You'll enjoy a competitive salary and benefits, as well as a host of other perks, including a nationally recognized wellness program, and a bright, open, award-winning office space in Northeast Minneapolis just minutes from major freeways and retail centers.
At UCare, we welcome and employ a diverse employee group committed to meeting the needs of UCare, our members, and the communities we serve.
UCare offers Medicare, Medicaid, Individual and Family health plans - powered by the hardest working people in the industry. Our people powered teams de-complicate, advocate and always go the extra mile to help our members. We serve with integrity, compassion and commitment to do right by members, providers and government partners. Above all, we come to work excited to provide members a path for the best health of their lives.
WORKING AT UCARE
Working at UCare is more than a career; it's a mission. A mission that defines us as professionals, unites us as an organization and shapes how we interact with our members and each other. Employees join UCare and stay because of the opportunity to have a purpose-driven job.
Our strong culture has established UCare as a Star Tribune Top 150 Workplace for 12 consecutive years since the awards program began. It's a culture that embraces innovative ideas, strategic partnerships, and exemplary customer and provider experiences. Working at UCare is being a part of a people powered team dedicated to making a real difference in the lives of our members and communities.
COVERAGE POLICY PROGRAM ANALYST SENIOR - GOVERNMENT PROGRAMS
Work Location: Standard or hybrid
The health and safety of our employees, members, providers, and our community is our highest priority. Therefore, all new employees are expected to be fully vaccinated against COVID-19 prior to starting at UCare, subject to limited exceptions such as for a sincerely held religious belief or for medical reasons.
This position is responsible to collaborate with coverage policy team members and other key departments to manage UCare's Medicare Plan Benefit Package (PBP) bid submission, and monitor changes to Medicare and State Public Programs (SPP) benefits. Serve as subject matter expert for internal departments, participate in various workgroups and committees. Perform complex functions as necessary to respond to requests from stakeholders, and for business continuity purposes. Manage the Medicare Advantage Plan Benefit Package (PBP) completion and benefit filing process.
• Review Medicare and Medicaid benefit changes, operational improvement opportunities, and benefit payment processes or clarifications that require project management. Serve as a research specialist for Medicare and Medicaid managed care benefits. Analyze and interpret regulatory and policy benefits for UCare teams.
• Prepare for and file annual Medicare Plan Benefit Packages (PBP's). This includes: downloading of PBP software, monitoring/reviewing and incorporating all CMS guidance concerning the PBP and Medicare Advantage benefit filing process, comprehensive testing of the PBP software, establishing plan structure in CMS' Health Plan Management System (HPMS) to support product filings, coordinating with Health Care Economics, the maintenance of the Medicare Advantage Plans and MSHO PBP's used for benefit filing documentation, providing feedback to CMS; coordinating with Government Relations on document alignment for upload, and completing PBP's for upload via HPMS.
• Participate in implementation of Medicare supplemental benefits, collaborating with other Product and Coverage team members.
• Serve as a member of UCare's Medicare Bids and Benefit's Workgroup, and other workgroups, as assigned.
• Collaborate with Coverage Policy Team members to develop and implement coverage policies, specifically in the area of Medicare and State Public Program.
• Support communication of coverage polices to internal departments. Identify training opportunities and provide training on coverage topics, coverage database and other topics.
• Develop and maintain the Coverage Policy SharePoint site, tools and database(s).
• Answer, triage and troubleshoot coverage policy questions and post-implementation issues.
• Other projects and duties, as assigned.
Bachelor's degree in Business Healthcare Administration or other relevant field; demonstrated experience may be considered in lieu of degree.
Five years of experience in a health care of a managed care setting. Knowledge of relationship between health plans and providers, including working knowledge of healthcare plans (Commercial, Medicare, Medicaid). Intermediate level of Microsoft Word, Excel, and PowerPoint experience. Familiarity with ICD-10, CPT, HCPCS and other code sets as they relate to healthcare plan benefits and claims payment administration. Experience managing complex projects.
Medicare Plan Benefit Package (PBP). Knowledge of the HMO industry preferred. Experience working in a matrixed environment.
THE UCARE DIFFERENCE
The UCare difference is our people power - employees actively working on the behalf of our members to get them access to the health care they need. We value and respect each individual's ideas and contributions, and provide the freedom to grow both personally and professionally. We are centrally located, and offer onsite education, equipment and wellness resources, and a myriad of volunteer activities. If you're looking for an inclusive environment that celebrates your people power, helps you build on your strengths and gives you the opportunity to truly make a difference, we invite you to apply.
A s an Equal Opportunity/Affirmative Action Employer, we welcome and employ a diverse employee group committed to meeting the needs of UCare, our members, and the communities we serve.
JOB POST DATE: 1/20/2022