JOB SUMMARY

The Manager Government Programs drives the development, operational implementation, and regulatory aspects of the Centers for Medicaid and Medicare Services (CMS) Medicare and Affordable Care Act (ACA) Marketplace products. Coordinates and manages a large, diverse stakeholder group including but not limited to CMS, vendors, and key System resources.

ESSENTIAL FUNCTIONS OF THE ROLE

• Manages Government Programs operations, and performance, and ensures appropriate allocation of resources needed to maintain the successful delivery of all required program components.
• Supervises staff which includes the responsibility for hiring, separation, performance evaluation, training, work allocation and problem resolution.
• Manages annual Medicare and ACA Marketplace program initiatives. Runs timelines, work progression, and deliverables to ensure accurate and timely CMS submission.
• Provides training and leadership for benefit development team and stakeholders as needed.
• Manages the coordination of various CMS benefit design, financial, regulatory and/or submission processes.
• Manages communication with applicable CMS representatives such as auditors, bid reviewers and help desk.
• Ensures responses are provided in a timely and accurate manner.
• Keeps senior leadership apprised of any potential barriers or concerns with any CMS review process.
• Serves as a subject matter professional; provides feedback and guidance to other departments on Medicare and ACA Marketplace programs, operations, benefits, marketing materials and other member or external facing documents for agents or members.
• Facilitates and manages legal, contracting, accounting, and finance internal approvals to assure compliance with CMS processes to help contract deliverables and required processes for program success.
• Manages procurement and RFP process for supplemental vendors for benefit and program value added services.
• Drives and coordinates CMS Readiness Reviews across all business functions and third-party vendors providing CMS guidance, interpretation assistance, and feedback as needed.

KEY SUCCESS FACTORS

• Experience working for CMS within the Medicare division or at a Medicare Advantage plan or Accountable Care Organization (ACO).
• Knowledge of Medicare benefits, CMS regulations, and health plan operations.
• Exceptional knowledge of clinical quality,, data analytics and financial metrics.
• Exceptional verbal and written communication skills.
• Exceptional project management and organizational skills.
• cross-functional work well within cross functional teams.
• Skilled with Microsoft PowerPoint, Excel, and Word.

BENEFITS

Our competitive benefits package includes the following

• Immediate eligibility for health and welfare benefits
• 401(k) savings plan with dollar-for-dollar match up to 5%
• Tuition Reimbursement
• PTO accrual beginning Day 1

Note: Benefits may vary based upon position type and/or level

QUALIFICATIONS

• EDUCATION - Bachelor's or 4 years of work experience above the minimum qualification
•  EXPERIENCE - 5 Years of Experience

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About Baylor Scott & White Health

Baylor Scott & White Health (BSWH) is the largest not-for-profit health care system in Texas and one of the largest in the United States. With a commitment to and a track record of innovation, collaboration, integrity and compassion for the patient, BSWH stands to be one of the nation’s exemplary health care organizations. Our mission is to serve all people by providing personalized health and wellness through exemplary care, education and research as a Christian ministry of healing. Joining our team is not just accepting a job, it’s accepting a calling!

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