Operations Analyst, Government Programs (EGWP)

Judi Health • Denver, CO

3d • $65,600 - $98,500 • Hybrid

About The Position

Judi Health is an enterprise health technology company providing a comprehensive suite of solutions for employers and health plans, including: Judi Rx, a public benefit corporation delivering full-service pharmacy benefit management (PBM) solutions to self-insured employers, Judi Health™, which offers full-service health benefit management solutions to employers, TPAs, and health plans, and Judi®, the industry’s leading proprietary Enterprise Health Platform (EHP), which consolidates all claim administration-related workflows in one scalable, secure platform. Together with our clients, we’re rebuilding trust in healthcare in the U.S. and deploying the infrastructure we need for the care we deserve. To learn more, visit www.judi.health.

Requirements

• Minimum of HS diploma/GED or equivalent experience
• 3+ years of Medicare Part D and/or EGWP experience
• Experience with Medicare Part D enrollment, call center and member communication requirements and reporting
• Experience working in a delegated and highly matrixed organization.
• Strong operational acumen
• Strong analytical acumen

Nice To Haves

• Health Plan Medicare Part D and/or EGWPs
• Experience working within CMS systems, including but not limited to HPMS and MARx.
• Experience with Federal and State Audits

Responsibilities

• Support EGWP program setup, implementation and go-live readiness across assigned internal functions and delegate oversight, which includes enrollment, claims processing, member services, member communications, CAHPS activities and associated member service STARs activities.
• Monitor daily, weekly and monthly performance, operational KPIs and CMS compliance metrics for enrollment, member services, and member communications.
• Support with issue resolution and corrective action completion with related, first tier and downstream entities (FDRs).
• Perform oversight of monthly enrollment audits performed by CMS and semi-annual enrollment reporting.
• Perform oversight of member services and member communications through call evaluations and random sample review or materials and documentation.
• Ensure timely and accurate reporting information is received from both internal and external resources as required by the Health plan.
• Collaborate with account management and/or employer groups on enrollment issues to be resolved by Employer groups to ensure timeliness and compliance with CMS guidance
• Develop compliant documentation for operational areas to include policies, procedures, workflows and other work instructions.
• Support additional functions, as needed.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: High school or GED