Manager, Government Programs (Enrollment)

Judi Health

$121K — $152K *
Healthcare
5 - 7 years of experience
Job Overview by Ladders

Qualifications

  • Minimum of HS diploma/GED or equivalent experience
  • 5+ years of Medicare Enrollment operations experience
  • Deep knowledge of Medicare enrollment regulations and CMS processing guidelines
  • Experience working within CMS systems like HPMS and MARx
  • Background in a delegated and highly matrixed organization

Responsibilities

  • Manage enrollment system setup and implementation processes
  • Provide leadership coaching and performance management to the team
  • Oversee daily Medicare enrollment and eligibility operations
  • Process Medicare enrollment and disenrollment transactions
  • Ensure compliance with CMS enrollment regulations
  • Lead issue resolution and corrective action processes
  • Conduct outreach on enrollment information and CMS processing errors

Benefits

  • Hybrid work model available for greater flexibility
  • Opportunity for professional development and career advancement
  • Collaborative work environment across departments
  • Engagement with regulatory compliance and awareness initiatives
  • Access to a supportive management team focused on employee growth
Full Job Description
Location: Hybrid (Local to NYC, Denver, CO or Charlotte, NC) Position Summary: The Government Programs Enrollment Manager is responsible for the implementation, overall management, oversight and continuous improvement of Medicare enrollment and eligibility operations for the Health Plan EGWP line of business. The role will be responsible for daily management and ongoing oversight of highly vulnerable activities with the Medicare part D Prescription Drug Plan (PDP) Employer Group Waiver Plan (EGWP). This position ensures timely, accurate and compliant processing of Medicare enrollment transactions while maintaining adherence to CMS regulations, contractual requirements and organizational service standards. Position Responsibilities: • Manage enrollment system build and program setup, implementation and go-live readiness, including developing business requirments, workflows, conducting testing and go-live activities. • Provides leadership coaching and performance management to Government Programs Enrollment staff to achieve departmental and organizational objectives. • Manage day to day Medicare enrollment and eligibility operations including premium billing. • Oversee processing of all Medicare enrollment and disenrollment transactions. • Ensure compliance with CMS enrollment regulations and service level agreements. • Manage issue resolution and corrective action completion. • Perform outreach as necessary on missing enrollment information, client file errors and CMS processing errors. • Manage monthly data validation audits performed by CMS contractors and respond timely and accurately. • Lead regulatory reporting to ensure timely and accurate reporting from both internal and external resources as required by the Health plan, the State and CMS. • Collaborate cross functionally across the Judi Health organization on employer group issues, communications and required oversight of enrollment related activities performed by employer groups. • Support internal and external audits by federal and state agencies, including audit preparation, documentation, issue response and remediation tracking. • Develop compliant documentation for operational areas to include policies, procedures, workflows and other work instructions. Required Qualifications: • Minimum of HS diploma/GED or equivalent experience • 5+ years of Medicare Enrollment operations experience • Deep knowledge of Medicare enrollment regulations and CMS processing guidelines. • Experience working within CMS systems, including but not limited to HPMS and MARx. • Experience working in a delegated and highly matrixed organization. Preferred Qualifications • Health Plan Medicare Part D and/or EGWPs • Experience with CMS, CMS Contractor and State Audits • Strong analytical acumen New York, NY Salary Range $146,000-$182,500 USD Denver, CO Salary Range $133,600-$167,000 USD Charlotte, NC Salary Range $121,600-$152,000 USD All employees are responsible for adherence to the Judi Health Code of Conduct including the reporting of non-compliance. This position description is designed to be flexible, allowing management the opportunity to assign or reassign duties and responsibilities as needed to best meet organizational goals.

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