Government Programs Specialist

Rosemont: Government Programs Specialist


We are seeking an experienced Government Programs Specialist for our Government Programs Department at our Chicago/Rosemont Location.

 

The Government Programs Specialist will be responsible for providing objective and professional evaluations of the organization’s operation, actively participate in major compliance programs/audits, and assist the Director as needed.  Additionally, you will ensure Compliance Audits are conducted, reported, and appropriate action taken.

 

Responsibilities and Functions:Research compliance / benefit questions for all departments Develop Q&A resource for internal departments (compliance help desk)Develop compliance policies / procedures based on federal and state regulations Distribute to organization Review department policies to ensure they comply with regulationsReview marketing/member pieces prior to filing with CMS Review language and disclaimers to ensure compliance with CMS regulations Revisit regulations with departments periodically to ensure clean pieces are submitted (i.e. staffing changes, new regulations, etc.)Attend departmental meetings at least monthly and deliver compliance updates

o  Discuss regulations, policies, benefits, MYBE, SAE, etc.Attend QIC meetings and deliver compliance updates Create executive summary of Compliance activity for previous month Compliance report key-indicatorsInternal Audits

o  Perform sales ride-along audits and silent monitoring of telemarketing and Customer Service Departments for local market; report results to Corporate Auditor

o  Work with Corporate Auditor when necessary to oversee CAP implementationTraining Develop training materials as needed based on new rules, policies, benefits, etc. Deliver training to internal departments Periodically revisit departments to deliver training as needed

 

Minimum Requirements:Bachelor’s Degree in a related field (4 years experience would be considered in lieu of degree); 2 years of experience in any combination of claims operations, medical coding/billing, physician/hospital administration, provider contracting, and eligibility or legal services; Commercial or Medicare experience preferred.One and one-half years of managed care or hospital management along with working knowledge of Medicare is preferred.

 

 

We offer a competitive salary and a full range of benefits.

 

To be considered, go to www.healthspringofalabama, click Employment and Apply & complete an online application.

 

Select Department:  Government Programs

Select Position: Government Programs Specialist

 

 

Attach resume. Include salary history/requirement. No phone calls accepted.

HealthSpring, Inc. is an EEO/AA employer.