Manager, Government Programs (Enrollment)

• 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.

• 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.

• Health Plan Medicare Part D and/or EGWPs
• Experience with CMS, CMS Contractor and State Audits
• Strong analytical acumen

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.

We provide equal employment opportunities to all employees and applicants for employment and prohibit discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, medical condition, genetic information, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws.

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