Medicare Product Implementation & Optimization (MPIO) Specialist (Operations)

The Medicare Product Implementation Specialist assists with the development, implementation, and/or monitoring of new and existing products across Medicare and Integrated Products to support business plan goals, maximize consumer experience, and enhance operational efficiency. Primary responsibilities may include but are not limited to implementing new benefits and services for these products, implementing enhancements to existing processes, and working on both enterprise projects & ad-hoc initiatives. The Medicare Product Implementation Specialist will work with cross-functional teams across all levels of staff, and across the enterprise, to provide support through operational development, project management and/or coordination, and end-to-end implementation of business processes. A Medicare Product Implementation Specialist at Healthfirst solves routine problems of limited scope and complexity following established policies and procedures. The successful candidate will be a team player who is results-driven, creative, and a detail-orientated individual with excellent verbal and written communication skills.

 

Duties & Responsibilities: 

• Leads or participates in product-driven workgroups, to provide input to product designs/enhancements and implementation plans 

• Works with key stakeholders (including, but not limited to Regulatory, Claims Configuration, Provider Ops, Appeals & Grievance, Medical Management, Enrollment & Billing, Sales) to identify, scope and accurately implement new benefits, services, or other product changes, update processes and/or edit systems to accommodate regulatory requirements 

• Assist with ad hoc projects such as focus group studies, process improvement initiatives and program implementations, when applicable 

• Coordinate activities of product or project-specific cross-functional work teams / serve as liaison between product management and all levels of staff to assure ongoing effective administration of products 

• Collaborate with various departments to ensure we are pro-actively troubleshooting issues and resolving them in a timely manner 

• Monitor internal policies/procedures and job aids on a regular basis to ensure compliance with regulatory requirements and consistence with actual activities 

• Support product management leadership in preparing and conducting product and lines of business (LOB) presentations and training to internal and external audiences 

• Plan, schedule, monitor, and report on activities related to a project or assignment; ensure communication to all impacted areas 

• Serve as a subject matter expert on product benefits and requirements to other business units 

 

Minimum Qualifications: 

• Bachelor’s Degree from an accredited college, 3-5 years of relevant experience; or any combination of education and experience that would provide an equivalent background. 

Preferred Qualifications: 

• Healthcare insurance and related experience 

• Experience with Microsoft Word, Excel, and PowerPoint 

• Strong organizational and project management skills 

• Some prior experience in the healthcare industry, specifically in health insurance 

• Strong work ethic, attention to detail, ability to effectively manage time, and commitment to developing quality work quickly 

• Ability to work independently 

• Strong presentation abilities and process-mapping experience 

• Excellent written and verbal communication 

WE ARE AN EQUAL OPPORTUNITY EMPLOYER. Applicants and employees are considered for positions and are evaluated witho