Notice ID: CMS210835
The purpose of this requirement is for oversight to ensure that web-brokers and issuers meet the required criteria necessary to conduct enrollments using both the classic Direct Enrollment (DE) and Enhanced Direct Enrollment (EDE) processes in the Federally-Facilitated Exchange (FFE).
At a minimum, the following knowledge and experience are required:
- PPACA and implementation of related CMS policies
- Understanding of the current CMS Health Insurance Exchanges and the attributes of the different types of exchanges
- Experience developing, analyzing, and maintaining performance models, compliance models, corrective action plans, quality assurance plans and standard operating procedures (SOPs)
- Experience with Healthcare industry claims related analyses
- Experience with SAS, SPSS, or other statistical analysis software
- Data Collection, Modeling, Analysis, and Visualization Experience
- Experience creating and maintaining databases and spreadsheets for analytical reporting
- Experience developing and implementing communications and training strategies and plans using multiple communications mechanisms
- Experience developing executive reports, presentations, and related materials summarizing, analyzing, and recommending solutions to trends and lessons learned from compliance reviews and activities
- Experience and understanding of CCIIO’s processes related to changes in Qualified Health Plan (QHP) status.
- Experience and understating of Agent Broker oversight activities
- Experience and understanding of regulations and guidance related to DE and EDE
- Experience and understanding of CCIIO’s processes related to onboarding of qualified web-brokers, issuers and other partner entities who may participate in enrollment using classic DE and/or EDE processes
- Experience in conducting comprehensive audit reviews of technical and business operations from qualifying web-brokers and issuers
- Experience working and coordinating with multiple internal and external stakeholders including state Department of Insurance (DOIs) to gain consensus on actions, resolutions, and other pertinent items.
- Experience in preparing paperwork reduction act (PRA) packages and 508 process and preparation…