Manager, Government Programs (Enrollment)

Capital Rx; New York (NY); Hybrid; USD 146,000 - 183,000; Full time

Job summary

Judi Health is a health technology company delivering unified claims processing for governments and health plans. The Government Programs Enrollment Manager leads Medicare enrollment and eligibility operations, ensuring CMS compliance and timely processing while directing audits and cross-functional collaboration.

Hybrid role local to NYC, Denver, or Charlotte with salary ranges shown. The role requires deep CMS knowledge, experience with HPMS/MARx, and a proven ability to manage in a matrixed

Qualifications

• 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.

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.

Skills

Medicare Enrollment

CMS Regulations

CMS Systems

Matrixed Organization

Education

HS diploma/GED

Job description

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.

Location: Hybrid (Local to NYC, Denver, CO or Charlotte, NC)

Position Summary

The Government Programs Enrollment Manager is responsible for the implementation, overall management, oversight and continuous improvement of Medicare enrollment and eligibility operations for the Health Plan EGWP line of business. The role will be responsible for daily management and ongoing oversight of highly vulnerable activities with the Medicare part D Prescription Drug Plan (PDP) Employer Group Waiver Plan (EGWP). This position ensures timely, accurate and compliant processing of Medicare enrollment transactions while maintaining adherence to CMS regulations, contractual requirements and organizational service standards.

Position 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.

Required Qualifications

• 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.

Preferred Qualifications

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

New York, NY Salary Range: $146,000 — $182,500 USD

Denver, CO Salary Range: $133,600 — $167,000 USD

Charlotte, NC Salary Range: $121,600 — $152,000 USD

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.

By submitting an application, you agree to the retention of your personal data for consideration for a future position at Judi Health. More details about Judi Health's privacy practices can be found athttps://www.judi.health/legal/privacy-policy.