Medicare Operations Analyst - EGWP & CMS Compliance

Capital Rx; New York (NY); Hybrid; USD 79,000 - 99,000; Full time

Job summary

Judi Health in New York is hiring a Government Programs Operations Analyst to support EGWP implementation and daily CMS-compliant health plan activities. The role handles enrollment, member services, and reporting to meet employer, member and plan objectives.

The position requires 3+ years in Medicare Part D/EGWP, strong analytical and operational skills, and experience in a matrixed organization. Hybrid work near NYC is available.

Qualifications

• Minimum of HS diploma/GED or equivalent.
• 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.

Responsibilities

• Support EGWP program setup, implementation and go-live readiness across internal functions.
• Monitor enrollment, member services, and CMS compliance metrics.
• Assist with issue resolution across related entities (FDRs).
• Oversee monthly CMS enrollment audits and semi-annual reporting.
• Oversee member services and communications via call evaluations and samples.
• Ensure timely reporting information from internal and external resources.
• Collaborate with account management on enrollment issues to ensure CMS guidance compliance.
• Develop compliant documentation for policies, procedures, workflows, and work instructions.
• Support additional functions as needed.

Skills

Medicare Part D

EGWP experience

CMS compliance

Analytical acumen

Operational acumen

Education

HS diploma/GED

Job description

Judi Health in New York is hiring a Government Programs Operations Analyst to support EGWP implementation and daily CMS-compliant health plan activities. The role handles enrollment, member services, and reporting to meet employer, member and plan objectives.

The position requires 3+ years in Medicare Part D/EGWP, strong analytical and operational skills, and experience in a matrixed organization. Hybrid work near NYC is available.