GENERAL SUMMARY
Ensures all policies and procedures are current, compliant with state and federal regulations, and observe Coventry’s annual review and approval process. Monitors and verifies amendments to applicable policies and procedures as a result of regulatory changes and/or business improvements. Serves as government policy subject matter expert. Provides expert consultation across departments for policy interpretation and application.
ESSENTIAL RESPONSIBILITIES
- Works cross-functionally with Medicare Operations to ensure policies and procedures reflect current business operations and regulatory requirements.
- Ensures Medicare Operations business owners review and revise policies and procedures as part of the annual review process, including securing the appropriate signatures for approval.
- Collaborates with business owneres to ensure CMS regulatory changes or internal change management controls are incorporated into policies and procedures.
- Accesses current regulations including federal register, CMS chapters, call letters, etc. to research ambiguous guidance. Works in conjunction with Corporate Compliance to provide regulatory direction to the Medicare Part D business.
- Develops and implements a streamlined communication process to effectively convey policy updates and enhancements.
- Maintains a repository of department-wide policies and procedures, including current and retired documents. Ensures repository integrates version control, queries, and reporting capabilities.
- Understands business processes, systems, tools, regulations, and structures, and how they interrelate to provide products and services that create value for Coventry customers and key stakeholders.
- Controls expenses while meeting operational, financial, and service requiirements.
- Performs other duties as required.
Qualifications:
JOB SPECIFICATIONS
- Bachelor’s degree or equivalent experience.
- Requires previous (3 to 5 years) experience in government programs.
- Requires in-depth knowledge of regulated lines of business and managed care policy and direction.
- Strong communication and negotiation skills.
- Ability to perform analysis and legal research to identify and clarify issues.
- Demonstrated problem solver and team player.
- Excellent interpersonnel and leadership skills.
- Effective communication and presentation skills.
- Ability to effectively coordinate multiple projects.
- Proficiency with desktop software applications such as e-mail, Word and Excel.
Coventry Health Care is an Affirmative Action/Equal Opportunity Employer, and we are committed to building a talented and diverse team.
Job: Professionals
Primary Location: King of Prussia, PA, US
Organization: 37910 - Medicare Part D Overhead
Schedule: Full-time
Job Posting: 2013-01-08 00:00:00.0
Job ID: 1310083