Position SummaryThe Government Programs Operations Analyst will be responsible for supporting the day-to-day operational tasks related to Medicare Part D, Medicaid and Health Exchange regulatory requirements, including but not limited to monitoring CMS, ACA Marketplace and state guidance, supporting regulatory reporting requirements and supporting root cause analysis documentation.
Position Responsibilities:Regulatory Monitoring & Assessment- Continuously monitor federal and state regulatory sources (e.g., CMS, state Medicaid agencies, HHS) for new or revised requirements
- Analyze proposed and final rules, guidance, and policy updates to determine applicability and business impact
- Summarize complex regulatory changes into clear, actionable insights for internal stakeholders
Impact Analysis & Implementation- Conduct impact assessments across business functions including operations, compliance, network, clinical, and technology
- Partner with subject matter experts to define business requirements and implementation plans
- Support prioritization of regulatory initiatives based on risk, complexity, and deadlines
Cross-Functional Coordination- Facilitate working groups and stakeholder meetings to drive alignment on regulatory changes
- Track progress of implementation activities and ensure accountability across teams
- Act as a central liaison between legal, operations, and clinical leadership
Documentation & Reporting- Maintain a centralized inventory of regulatory changes and implementation status
- Develop executive-level summaries, dashboards, and status reports
- Ensure documentation meets audit and compliance standards
Compliance & Risk Support- Partner with Compliance to ensure adherence to regulatory requirements
- Identify risks, gaps, and dependencies associated with regulatory changes
- Support audit readiness and remediation efforts as needed
- Investigate regulatory-related defects and/or client compliance concerns and develop root cause analyses when necessary.
Process Improvement- Enhance regulatory change management processes, tools, and governance frameworks
- Drive standardization and efficiency in how regulatory changes are tracked and implemented
- Recommend automation or workflow improvements where applicable
Audit Support- Support client or government led audits as a regulatory compliance expert through:
- Research and analysis
- Documentation and as a speaker
- Workflow and Judi navigator
Required Qualifications:- Bachelor's degree in Healthcare Administration, Public Policy, Business, or related field
- 3+ years of relevant experience in healthcare, government programs, compliance, or regulatory analysis
- Thorough knowledge Medicare regulatory requirements and associated product and/or operational workflows
- Proven ability to interpret complex regulatory language and translate into business impact
- MS Office Skills
- Excel: ability to create/maintain pivot table, forms, and formula's (i.e. vlookup, true, if, left, etc)
- PowerPoint: create and maintain accurate and up-to-date slide decks for Government Programs functions
- Word: Supporting P&P, SOP, and Job Aide change management
- Ability to balance multiple complex projects simultaneously
- Excellent analytical, organizational, and project management skills
- Attention to detail & commitment to delivering high quality work product
This range represents the low and high end of the anticipated base salary range. The actual base salary will depend on several factors such as: experience, knowledge, skills, and location of the job.
Remote, US Salary Range
$72,800-$109,000 USD
New York, NY Salary Range
$87,200-$109,000 USD
Denver, CO Salary Range
$80,000-$100,000 USD
All employees are responsible for adherence to the Capital Rx 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.
