- Assess current policies and procedures through review of trends, data, materials, and operational practices.
- Research evidence-based programs, innovative solutions, and best practices employed in other states, companies.
- Prepare policy recommendations, including proposed changes, rationale, and potential legal/regulatory and/or fiscal impacts.
- Assist with implementation of policy and procedure changes, including messaging and training of internal and external stakeholders.
- Serve as the Medicare Advantage Account Manager for relationships with partners.
- Help develop, implement, and manage provider network compliance components of Medicare Advantage.
- Document and maintain Government Programs’ Standard Operating Procedures.
- Maintain documentation of meeting agendas/minutes/notes related to government programs.
- Support contract requirements of South Dakota Medicaid, including reporting, Provider Manual maintenance, and annual coverage recommendations.
- Proactively identify industry trends, competitive information and other market environmental factors and report findings to Director of Government Programs and Professional Services.
- Maintain confidentiality of protected health information and protect confidential business information; ensure compliance with state and federal laws and regulations, including the Health Insurance Portability and Accountability Act (HIPAA).
- Collaborate with other Delta Dental member companies as needed.
- Attend and present at internal company meetings as needed.
Experience and qualifications
- Bachelor’s degree is preferred.
- General knowledge or understanding of Medicaid and Medicare is helpful.
- Excellent oral and written communication skills, including strong presentation, sales and negotiation skills and the ability to interact with internal and external stakeholders in an effective and positive manner.
- Ability to communicate complex processes clearly and concisely.
- Strong analytical and problem-solving skills, including the ability to evaluate situations or data, identify options and generate solutions.
- Ability to demonstrate applied learning skills, including grasping new ideas and integrate them into desired results.
- Computer proficiency in Microsoft Office applications – Word, Excel, Outlook, PowerPoint, and Teams.
- Ability to navigate the Internet and web services for research purposes.
- Strong self-motivation and ability to work independently.
Compensation and benefits
Delta Dental provides an excellent compensation and benefit package
including medical, dental, vision, life & disability insurance, paid
vacation, sick leave, continuing education and 401k. More information
about benefits and company culture is available on our Careers page.