Summary

Palmetto GBA is one of the nations largest providers of high-volume claims and transaction processing contact center operations and technical services to the federal government and other commercial customers. Our core business is providing services to CMS Medicare beneficiaries providers and health plans. Palmetto GBA is one of the few Medicare contractors with experience in all Medicare business segments Medicare Part A Medicare Part B Durable Medical Equipment (DME) Home Health and Hospice (HHH) and Medicare Advantage (MA) Part C and Part D. This broad experience base offers CMS a contractor with unique expertise and the ability to offer customized creative and proven solutions to complex problems.

Description

Position Purpose:

Leads and administers projects. Monitors and facilitates progress and status of area projects and coordinates each project phase. Prepares specialized reports and presentations for management or staff as it relates to the progress of new projects and initiatives. Serves as liaison point of contact between department other external provider organizations and vendors for various purposes. Leads various teams to reach common goals. Conducts budgeting activities as needed.

The candidate for this position will be Subject Matter Expert (SME) and Key Personnel on the Advanced Provider Screening contract.

The Federal Healthcare SME role is vital to the program acting as a bridge between technical teams and business objectives. This position navigates essential data processes contributes to product management efforts and maintains direct ongoing interactions with both CMS systems and business stakeholders. Additionally it actively participates in technical solution development ensuring the mission remains central to all strategies moving forward.

What You Will Do:

• Organize and direct projects and activities for divisions or assigned areas. Prepares materials such as legally compliant and referenceable meeting minutes reports charts visual aids etc. Monitors departmental methods to ensure compliance with internal measures and contract/business requirements.
• Reviews items directed to management. Advises and keeps management apprised of any potential issues or items that need to be addressed. Recommends a response or solution to any issues identified or outstanding. Assists management with complex reviews such as analysis of expenditures. Manage/relay project status purpose scope and timing.
• Serve as liaison between the division or department and other areas provider organizations vendors etc. Attends participates and facilitates executive meetings between large Provider organizations and BCBSSC.
• Manage and prepare contract modifications. Research legal and compliance concerns and provides education to area on topics.
• Supervises staff to include approval of time leave performance reviews etc. Selects/trains/motivates staff. Other assigned duties such as facilitating positive outcomes for vendor relationships leading provider and internal meetings facilitate resolution of issues.

To Qualify For This Position You Will Need:

Required Education:

• Bachelors
• Or and additional 4 years job related work experience
• Or an Associates plus an additional 2 years job related work experience

Specialized Training:

• A comprehensive knowledge of the HHS Code of Federal Regulations and the Medicare Program Integrity Manual (PIM) and the Medicare Provider Enrollment process.
• Federal Healthcare Program SME - Key - Acts as government healthcare business advisor to CMS and APS Contractor.
• Analyzes processes proposes solutions and defines requirements for Medicare Medicaid and Federal Healthcare Programs.

Required Work Experience:

• 6 years-of progressively responsible experience in project coordination or operations support experience to include 2 years of project coordination experience including leading projects teams

Required Skills and Abilities:

• Excellent verbal written and interpersonal communication skills.
• Ability to work well with all levels of internal and external management and staff as well as outside clients and vendors.
• Excellent organizational skills and project management skills.
• Good judgment. Ability to handle confidential or sensitive information with discretion.
• Ability to persuade negotiate or influence.
• Analytical or critical thinking skills.
• Strong attention to detail.

Required Software and Tools:

• Microsoft Office Smart Sheets

We Prefer That You Have:

• A comprehensive knowledge of the HHS Code of Federal Regulations and the Medicare Program Integrity Manual (PIM) and the Medicare Provider Enrollment process.
• Experience as a Federal Healthcare Program SME - Key - Acting as a government healthcare business advisor to CMS and APS Contractor.
• Experience analyzing processes proposing solutions and defining requirements for Medicare Medicaid and Federal Healthcare Programs.

What We Can Do for You:

We understand the value of a diverse and inclusive workplace and strive to be an employer where employees across all spectrums have access and opportunity to develop their skills advance their careers and contribute their unique abilities to the growth of our company.

Our comprehensive benefits package includes:

401(k) retirement savings plan with company match

Subsidized health plans and free vision coverage

Life insurance

Paid annual leave the longer you work here the more you earn

Ten paid holidays

On-site cafeterias and fitness centers in major locations

Wellness programs and a healthy lifestyle premium discount

Tuition assistance

Service recognition

What to Expect Next:

After submitting your application our recruiting team members will review your resume to ensure you meet the qualifications.This may include a brief telephone interview or email communication with our recruiter to verify resume specifics and salary requirements. Management will be conducting interviews.

Equal Employment Opportunity Statement

BlueCross BlueShield of South Carolina and our subsidiary companies maintain a continuing policy of nondiscrimination in employment to promote employment opportunities for persons regardless of age race color national origin sex religion veteran status disability weight sexual orientation gender identity genetic information or any other legally protected status. Additionally as a federal contractor the company maintains affirmative action programs to promote employment opportunities for individuals with disabilitiesand protected veterans. It is our policy to provide equal opportunities in all phases of the employment process and to comply with applicable federal state and local laws and regulations.

We are committed to working with and providing reasonable accommodations to individuals with disabilities pregnant individuals individuals with pregnancy-related conditions and individuals needing accommodations for sincerely held religious beliefs provided that those accommodations do not impose an undue hardship on the Company.

If you need special assistance or an accommodation while seeking employment please email or call ext. 47480 with the nature of your request. We will make a determination regarding your request for reasonable accommodation on a case-by-case basis.

We participate in E-Verify and comply with the Pay Transparency Nondiscrimination Provision. We are an Equal Opportunity Employer. Heres moreinformation.

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