NAVITUS HEALTH SOLUTIONS LLC Government Programs Customer Care in APPLETON, Wisconsin

JOB REQUIREMENTS: Develops and maintains deep subject matter expertise related to Medicare Part D, Exchange and Medicaid requirements Works with Customer Care Leadership to monitor, interpret and communicate Medicare, Exchange and Medicaid regulations, guidance, and system changes Assists with the development and maintenance of product documentation and training materials for Customer Care Works closely with Government Programs Program Management to ensure that the appropriate processes and procedures are implemented within Customer Care and cross-functionally between departments Assists with preparation for and execution of CMS audits, Medicaid delegation audits, and other audits as needed Collaborate with the Customer Care content management team to ensure Medicare, Exchange and Medicaid client resources are developed, maintained, and translated appropriately Maintain in-depth knowledge of Navitus' claims processing software and other applications and reporting tools as applicable Create, test and implement enhancements to the claims processing system for increased adherence to government-mandated processes Lead improvements that support client/CMS expectations and ongoing continuous improvements focused on enhancing efficiency and accuracy of department processes Reviews work of Specialists to ensure compliance with specific attention paid to areas of risk like coverage determinations and complaints Outline and execute on processes to proactively monitor department compliance with requirements With Leadership, identify key performance indicators, request and test reports to monitor these indicators, set goals for indicators, and create plans to improve when goals are not met. Travel to client or auditing body sites as requires for audit participation Provide effective communication of Navitus' vision, mission, values, goals and policies Learn and abide by company and departmental policies and procedures while maintaining a professional business environment Navitus Health Solutions is an Equal Opportunity Employer: Disabled/Veterans/Male/Female/Minority/Other ***** APPLICATION INSTRUCTIONS: Apply Online: