Government Programs Operations Analyst - Reprocessing Specialist

Transformcap; Colorado; Hybrid; USD 82,000 - 124,000; Full time

Job summary

Judi Health is seeking a Government Programs Operations Analyst to support Medicare, Medicaid, Exchange, and Commercial lines. You will serve as the Reprocessing & Reversals subject matter expert, executing and validating R&R activities and guiding cross-functional teams to ensure compliant, scalable processes.

Responsibilities include testing, documentation, and collaboration with Product and Development to implement enhancements, while maintaining audit-ready evidence and regulatory alignment

Qualifications

• 3+ years of PBM or health plan operations experience.
• Subject matter expert in pharmacy claim reprocessing and reversals.
• Advanced MS Excel skills; familiarity with SQL or data tools is a plus.
• Strong analytical, communication, and CMS compliance skills.

Responsibilities

• Serve as the primary Reprocessing & Reversals (R&R) SME across applicable lines of business.
• Run and validate R&R activities including complex reversals and corrections.
• Partner with Product and Development to define R&R requirements and prioritize enhancements.
• Perform testing, document outcomes, and coordinate with Product/Development through implementation.
• Establish and maintain R&R procedures, controls, SOPs, and audit-ready evidence.
• Provide R&R guidance and training to Operations, Client Services, Product, Development, and other stakeholders.
• Conduct root cause analysis of R&R and claims issues and implement corrective actions.
• Handle PDE, Medicare Plan Finder, and Encounter Data submissions; assess downstream impacts.
• Support error handling and change management for PDE and encounter submissions.
• Stay current on CMS guidance and translate updates into operational strategies.
• Share R&R knowledge with team members; maintain Medicare & Medicaid knowledge.
• Maintain knowledge of Medicare & Medicaid requirements to facilitate compliance.

Skills

Excel

SQL

Regulatory compliance

Analytical skills

Cross-functional collaboration

Documentation

Tools

MS Excel

Job description

Judi Health is seeking a Government Programs Operations Analyst to support Medicare, Medicaid, Exchange, and Commercial lines. You will serve as the Reprocessing & Reversals subject matter expert, executing and validating R&R activities and guiding cross-functional teams to ensure compliant, scalable processes.

Responsibilities include testing, documentation, and collaboration with Product and Development to implement enhancements, while maintaining audit-ready evidence and regulatory alignment