Kaiser Permanente
Business Process Consultant, Medicare Operations
Oakland, Burbank, or San Diego
The National Medicare Administration team is seeking a Business Process Consultant, Medicare Operations. The individual in this role is responsible for assessing critical ongoing operational processes that are managed by the National Medicare Administration (NMA) team, implementing process improvements, and assisting NMA staff with performing the ongoing, operational process management work, including quality assurance and testing responsibilities.
The NMA team's operational processes are typically data-driven and based on Medicare requirements. The initial focus of the consultant will be on processes that support Retiree Drug Subsidy (RDS) administration, generation of the Medicare Part D Explanation of Benefits (Part D EOB), and Medicare Sales Incentive Compensation. An expanded focus on additional processes may be undertaken as time permits.
Essential Functions:
- Data Analysis: Identifies sources for, gathers and analyzes data relevant to processes. May review the work of less senior analysts/consultants. May be responsible for defining data requirements and obtaining customer agreements.
- Research: Reviews best practice research prepared by less senior analysts/consultants. Makes recommendations on appropriate solutions based on research; may select from alternatives presented.
- Process Architecture: Designs complex processes and reviews the work of less senior analysts/consultants. Ensures process mapping is complete; provides feedback and guidance to less senior analysts/consultants. Interviews stakeholders and process owners to define processes. Helps define standards and methods.
- Process Recommendations: Determines process recommendation documents, including presentations, process maps, supporting metrics, business requirements and related impact analyses for complex processes or for portions of larger or inter-related processes. May lead the development of recommendations by less senior analysts/consultants. May apply Lean/Six Sigma concepts and techniques to process improvement initiatives, including completing Lean/Six Sigma analyses and tasks. Shares accountability for realization of results with process owners and may present recommendations to stakeholders and process owners.
- Performance Management and Control: Defines, develops and evaluates performance metrics to establish process success, and may participate in working with multiple stakeholders, often with competing/conflicting objectives, to ensure cohesive and reachable measures of success. Reviews data post- implementation to measure success; participates in defining standards of improvement success.
- Change Management: Participates in and may lead change management activities associated with process improvement. Engages leadership and stakeholders to obtain support and buy in for changes. Partners with management, project champions, and process owners to align process improvement initiatives with business objectives.
- Assume other duties as directed.
- Travel 10-20% of the time.
Qualifications:
Basic Qualifications:
- 4+ years of process improvement, management consulting, change management, or related business experience
- Bachelor's degree or 4 additional years of equivalent experience
- Broad knowledge of process improvement methodologies
Preferred Qualifications:
- 9+ years of process improvement, consulting, or related business experience.
- Strong Excel and Access database skills
- Health care or insurance experience
- Medicare knowledge
- Graduate degree
External hires must pass a background check/drug screen.
We are proud to be an equal opportunity/affirmative action employer.