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 200 Workplace for 14 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.
CCO REGULATORY MATERIALS SPECIALIST
Work Location: Work from Home or Office for Your Day
As the Configuration and Claims Operations (CCO) Compliance Business Analyst, you will be responsible to serve as the internal CCO Subject Matter Expert for all Federal, State, Commercial and CMS and DHS regulatory and billing guidelines. Serve as the regulatory Subject Matter Expert (SME) for CCO project teams and provide ongoing guidance and regulatory interpretation and training to impacted CCO teams. Perform a wide variety of activities including research, review, documentation of business requirements, translation communication and ongoing monitoring of regulations and Compliance 360 FYIs and tasks. Collaborate with CCO teams to identify associated impacts to configuration, policies/procedures, job aids and other operational tasks. Create educational and reference materials to support a more comprehensive understanding of regulatory changes and their impacts to CCO operations. Collaborate with UCare's centralized training department to ensure all claims job aids accurately reflect the most current regulatory updates and include the appropriate source information and references.
• Responsible for monitoring the regulatory landscape for CCO and collaborating with other CCO and UCare stakeholders to identify and communicate updates to Medicare Advantage Part C/D, DHS, Special Needs Plan (SNP) and Medicare Supplement regulatory changes, DHS contract changes, claims processing instructions, and other changes in support of timely and accurate operational implementation and ongoing maintenance.
• Provide initial review, interpretation, creation and dissemination of regulatory updates and Compliance 360 FYIs and tasks to the applicable teams/individuals within CCO.
• Establish and maintain regulatory briefings, resource materials, business requirements, written job aids and other documentation and workflows to facilitate understanding and compliance with regulatory standards. Create a centralized repository of information for CCO teams to reference.
• Represent CCO as a participant and SME in regulatory and compliance-related committees and workgroups, as assigned.
• Collaborate cross-functionally with UCare business partners (Legal, Government Relations, Coverage Policy, Payment Policy, Product, Pharmacy, etc.) to ensure alignment and accurate interpretation and understanding of regulatory guidelines impacting operational implementations and accurate claims processing.
• Perform periodic claims reviews/assessments to ensure claims are processing according to regulator and contractual expectations.
• Analyze and respond to CCO internal team questions regarding regulatory interpretation.
• Develop and maintain a familiarity with applicable claims adjudication systems.
• Other projects and duties as assigned.
Bachelor's degree preferred; experience with related disciplines and demonstrated capability through previous experience may be considered in lieu of degree.
Five years in health care compliance, health insurance and/or managed care. Medicare Part C or D and DHS program administration experience. Experience reviewing, analyzing, interpreting and communicating regulatory guidance. Experience writing business requirements.
Working knowledge of Medicaid, Medicare and Commercial Insurance Products and Regulations. Experience using Compliance 360. Experience with writing, developing and implementing managed care policies, procedures and training materials. Coding certification is a plus.
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.
As 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: 4/19/2023