Medicare Business Consultant
The Medicare Business Consultant is responsible for the development and tracking of business solutions and projects to support the Medicare LOB including but not limited to: 1. Analysis and recommendations for business alternatives to inform and solve for strategic business or operational problems; 2. Development and documentation of business process solutions for new or existing areas of focus; 3. Development, tracking and monitoring of project plans, issues/risk logs and decisions.
* Designs processes and makes recommendations on appropriate solutions based on research. Prepares 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.
* Develops, and communicates project plans, approaches and success metrics. Continuously monitors progress, and takes corrective actions that ensure successful achievement of project goals.
* Leads and manages complex work streams, multiple projects and associated project teams that are cross-functional and multidisciplinary.
* Identifies data source, gathers and analyzes data relevant to processes identified for process improvement initiatives. Completes stakeholder/process owner interviews, researches and summarizes best practice to define processes.
* Acts as a Medicare Subject Matter Expert (SME) providing consulting support and thought partnership with other business leads or project managers and leaders as required.
* Maintains cohesion, focus, and productivity among diverse local and national team members. Helps team members think creatively to overcome issues and determine solutions.
* Effectively communicates project status to the Medicare teams including Senior Management and Medicare Leadership.
* Recognizes and works effectively in complex, political, and ambiguous situations. Uses organization and personal influence strategies to encourage desired behavior among those involved to reach goals of the project.
* Meet with key players to test ideas, identify issues and gain commitment on recommendations.
* Develop and clearly communicate the contributing factors of business value for programs and KP.
* Develop and analyze program interdependencies to mitigate risks, avoid issues and identify opportunities to improve process.
* Design strategically aligned approach by identifying operational and strategic implications throughout program work.
* Create a clear, logical and realistic plan of activities which streamlines the program process.
* Analyze and anticipate how one program or recommendation may impact or interfere with other programs or initiatives.
* Identify barriers to change and accept and manage ambiguity / complexity in programs/program, and effectively guide teams in dealing with change barriers and program constraints.
* Bachelor's degree in healthcare, business administration or a related field. Masters degree preferred.
* Five years project management experience.
* Five years analytical, process improvement or related experience required.
* Visio and Microsoft Project experience required.
* Ability to manage and execute on assignments of diverse and complex scope.
* Ability to interpret less defined guidelines to make recommendations for process improvements and/or enhancements.
* Requires complex planning to coordinate with other departments or resources, including knowledge of the business cycle.
* Ability to build and manage complex program plans and dashboards.
* Excellent written and oral communications skills are required.
* Strong facilitative leadership and business problem solving skills are required.
* Ability to effectively interact with a diverse workforce and cross functional groups required.
Preferred Work Experience and Qualifications:
* Sig Sigma certification or knowledge preferred.
* PMI certification preferred.
* Medicare or government programs experience preferred.
* Knowledge of health insurance regulatory and contractual requirements preferred. (No Value)