GDIT is preparing to support the Centers for Medicare and Medicaid (CMS) Office of Financial Management (OFM). The CMS OFM is responsible for reducing healthcare exchange errors by establishing a measurement for the improper payment of Advanced Payments of the Premium Tax Credit (APTC) in a given benefit year while accounting for changes in the Patient Protection and Affordable Care Act (PPACA or ACA) policy and regulations.
The ACA is a comprehensive health care reform law enacted in March 2010. The law makes affordable health insurance available to more people, provides consumers with subsidies (“premium tax credits”) that lower costs for households with incomes between 100% and 400% of the federal poverty level, and supports the expansion of the Medicaid program to cover all adults with income below 138% of the federal poverty level.
An opportunity is expected for a Cycle Coordinator to audit sample Marketplace applications to identify improper payments of the APTC. The sample universe for review may range from approximately 2,600 to 10,000 per evaluation cycle.
In this role you will:
Establish the sample universe based on the program’s operating plan
Prepare comprehensive reports that outline the results of the eligibility review samples for the customer
Report lessons learned and use that information to update “best practices” quarterly
Make significant contributions to the Difference Resolution and Appeals process, corrective action plans, and other related progressions
Create substantial narrative reports which concisely describe factual findings, applicable rules and reasoning employed to arrive at conclusions to support administrative recommendations
Use project management skills and workflow tracking tools
Oversee ACA Analysts and QA Analysts, ensure the correct samples are being run for each cycle, and communicate trend analysis, per review sample cycle
Stay abreast of State-Based Marketplaces guidelines, eligibility, and consumer-facing webpages
Perform root cause analyses for eligibility review and reporting business processes
Liaise between EIPM’s Functional Manager, eligibility analysts, data analysts, and quality analysts, especially to facilitate information sharing and problem solving.
Perform statistical data inspections based on random sampling
Confirm payment accuracy to identify improper APTC payments
Prepare Error Confirmation Packages. Create an audit trail of the review procedures performed, data and records reviewed, and findings
Draft final EIPM Cycle report containing detailed descriptions of all support activities, including a summary of QA and QC activities (i.e., audits and surveys) as well as results and follow-up actions
Present current and cumulative data, as well as plans for future performance monitoring and forecasts
Build case files for each grievance and ensure compliance with organizational and regulatory guidelines
Attend and participate in meetings, training, work groups and quality initiatives as assigned
Articulate findings to recommend impactful corrective actions
Additional strategic planning duties as assigned
Knowledge of ACA enrollment criteria, ACA legislation, federal guidelines, standard payment measurement procedures, and understand related regulatory and healthcare policy changes at the national level
5 or more years of related experience
Foreign language proficiency a plus
Knowledge in public health
We are GDIT. The people supporting some of the most complex government, defense, and intelligence projects across the country. We deliver. Bringing the expertise needed to understand and advance critical missions. We transform. Shifting the ways clients invest in, integrate, and innovate technology solutions. We ensure today is safe and tomorrow is smarter. We are there. On the ground, beside our clients, in the lab, and everywhere in between. Offering the technology transformations, strategy, and mission services needed to get the job done.
GDIT is an Equal Opportunity/Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or veteran status, or any other protected class.