Manager, Government Programs (Enrollment)
About The Position
Judi Health is a health technology company providing benefit administration solutions to employers, unions, health plans, and government entities. Judi Health replaces fragmented, outdated systems with the industry's first Unified Claims Processing™ architecture, seamlessly consolidating pharmacy and medical benefit administration on a single, secure platform. By delivering true price transparency, eliminating unnecessary middleman fees, and leveraging advanced AI-powered care delivery, Judi Health helps clients achieve unprecedented operational efficiency and service levels. At Judi Health, we're deploying the infrastructure our country needs to deliver the healthcare we all deserve. We are the intelligence platform powering benefits plans for millions of Americans and proudly leading the next generation of care. To learn more, visit www.judi.health.
Requirements
- 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.
Nice To Haves
- Health Plan Medicare Part D and/or EGWPs
- Experience with CMS, CMS Contractor and State Audits
- Strong analytical acumen
Responsibilities
- Manage enrollment system build and program setup, implementation and go-live readiness, including developing business requirements, 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.
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What This Job Offers
Job Type
Full-time
Career Level
Manager
Education Level
High school or GED
