Medicare Enrollment Programs Lead

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 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