- Program & Project Management
- Develops and communicates overall program strategy to ensure that business requirements are fulfilled across all ACA QHP program activities and projects.
- Ensures operations and processes throughout the organization for HMSA's ACA QHP business are compliant with federal and state contractual, regulatory, sub-regulatory and Qualified Health Plan certification requirements.
- Manages all aspects of the planning, execution, and closure of multiple such projects at a given time. Evaluates and refines best practices, program office standards, procedures, and quality objectives.
- Develops and maintains a productive working relationship with project stakeholders, business relationship managers, project office managers, and other management and staff as necessary to provide oversight on the ACA QHP program's activities and projects.
- Analyzes state and federal regulatory issues, explaining complex technical issues and rulemaking in terms that are non-technical.
- Monitor project milestones, timelines, technical deliverables, resource usage, critical dates, scope, costs, and quality to identify and minimize potential risks.
- Manages vendor relationships in support of program goals.
- Provides coaching and mentoring less experienced department personnel.
- Leads regulatory audits for the QHP program.
- Assigns, tracks, and responds to objections and findings from the state and federal government.
- Monitors and identifies shifting regulatory trends and areas of focus and interest to the government, ensuring HMSA is prepared in advance of the introduction of significant regulatory and requirement changes.
- Annual QHP Recertification
- Manages, leads, and is responsible for the efficient and effective management of the company-wide effort to submit HMSA's recertification application.
- Ensures all operational requirements to include coordinating efforts among virtually every major function within the organization and with our partners/vendors are met.
- Oversees all activities related to the research, analysis, and coordination of required plan changes, benefit proposals and changes, rate and financial calculations and adjustments, artifact revisions and updates, and impact to all internal departments.
- Submits required documents to CMS for their review and approval and responds to any inquiries they may have. Works with appropriate areas including legal on the annual contract review/approval process.
- Ensures the accurate and timely implementation of all plan and benefit changes with all affected departments.
- Documents all aspects of QHP program requirements, methodology, task schedule, and analytical results including interpretation of results, summary findings, and presentation reports.
- Works with staff and management in own and other departments as required to fully understand business scope, business constraints, and business implications of analytical results.
- Identifies all incoming needs, develop, maintain and coordinate cross departmental user requirements and application requirements for new requirements that affect the ACA QHP program.
- Standard Reporting Management & Oversight:
- Oversees and coordinates complex reporting and certification/filing activities on behalf of the organization and all involved departments, including the annual QHP certification, Market Conduct Annual Statement (MCAS) reporting, HIOS/RBIS filings, and ensuring all federal and regulatory expectations and deadlines are met.
- Produces reports summarizing projects, objectives, methods & findings of program significance, for both internal and external (federal/state) recipients.
- Documents issues, background, data, methods, problems, alternatives, and results.
- Perform all other miscellaneous duties and leads special projects as assigned or directed.
|
HMSA
Oct 12, 2024