Government Programs Operations Manager (Medicare)

at  Capital Rx

POSITION SUMMARY:

The Government Programs Operations Manager is responsible for the installation, change management and oversight of Medicare, Medicaid and Exchange government programs using research, analysis, testing and validation as tools. This role will interpret guidance from CMS/States government in collaboration with the compliance team to deliver on the business goals and comply with federal/state regulatory requirements.

REQUIRED QUALIFICATIONS:

• 6+ years of relevant PBM and/or Health Plan experience supporting Medicare Part D
• Thorough knowledge Medicare regulatory requirements and associated product and/or operational workflows
• MS Excel Skills – ability to create/maintain pivot table, forms, and formula’s (i.e. vlookup, true, if, left, etc)
• Ability to balance multiple complex projects simultaneously
• Extremely flexible, highly organized, and able to shift priorities easily
• Attention to detail & commitment to delivering high quality work product
• Excellent written and verbal communication skills
  Base Salary: $95,000 - $105,000
  Nothing in this position description restricts management’s right to assign or reassign duties and responsibilities to this job at any time.

• Identifies opportunities for improvement and participates in the development of new solutions/capabilities in support of government program compliance and audit readiness
• Collaborate with Compliance to oversee timely implementation of regulatory & sub-regulatory guidance, coordinating tasks & work plans across impacted operational departments
• Manage error handling and change management for PDE/Encounters, plan finder, etc.
• Monitor internal government programs operations and resolve any identified operational errors, including root cause analysis and the development and implementation of necessary actions
• Support claims correction for retro-eligibility changes and COB
• Support audits of government programs (government, client or internal)
• Documents policies and procedures, reporting and project specifications, job aids and workflows within the department
• Leverage deep understanding of Medicare & Medicaid market, regulatory environment to support product strategy and service delivery
• Maintain current knowledge of Medicare & Medicaid requirements to facilitate compliance of ongoing business operations
• Foster a high-performance culture through mentoring collaboration. Provide team members with constant and consistent performance feedback/direction. Assess impact of new business to understand scalability and staffing needs