Medicare Enrollment Ops Lead - Government Programs

Triwill Group; New York (NY); Hybrid; USD 121,000 - 183,000; Full time

Job summary

Judi Health is seeking a Government Programs Enrollment Manager in a hybrid role. You will oversee Medicare enrollment and eligibility operations for the EGWP line, ensure CMS regulatory compliance, and drive timely processing of enrollment transactions.

Leading a cross-functional team, you will implement system builds, go-live readiness, and audit responses while developing compliant policies and workflows. This role requires deep CMS knowledge and strong leadership in a matrixed environment.

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 with CMS systems including HPMS and MARx.
• Experience in a delegated, highly matrixed organization.

Responsibilities

• Manage enrollment system build and program setup, implementation and go-live readiness.
• Provides leadership coaching and performance management to Government Programs Enrollment staff.
• 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.
• Lead regulatory reporting to ensure timely and accurate reporting from both internal and external resources as required.
• 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 operations

CMS rules and guidelines

HPMS and MARx experience

Leadership / management

Education

HS diploma/GED

Job description

Judi Health is seeking a Government Programs Enrollment Manager in a hybrid role. You will oversee Medicare enrollment and eligibility operations for the EGWP line, ensure CMS regulatory compliance, and drive timely processing of enrollment transactions.

Leading a cross-functional team, you will implement system builds, go-live readiness, and audit responses while developing compliant policies and workflows. This role requires deep CMS knowledge and strong leadership in a matrixed environment.