Government Program Operations Specialist
USFull-TimeMiddle
Salary69,200 - 109,000 USD per year
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Job Details
- Experience
- 3+ years of experience in operations, healthcare, or a related field
- Required Skills
- Communication SkillsProblem SolvingOrganizational skillsInterpersonal skills
Requirements
- 3+ years of experience in operations, healthcare, or a related field, with exposure to government programs preferred.
- Familiarity with Medicare Part D, Medicaid, Exchange programs, or pharmacy/PBM operations is strongly preferred.
- Strong attention to detail with excellent organizational and documentation skills.
- Ability to manage multiple priorities in a fast-paced, high-volume operational environment.
- Experience working with claims data, reconciliation processes, or healthcare operations workflows is an advantage.
- Strong communication and interpersonal skills with a collaborative and service-oriented mindset.
- Ability to work independently while effectively coordinating across teams and stakeholders.
- High level of adaptability, problem-solving ability, and comfort working under pressure.
Responsibilities
- Manage daily operational workflows for Government Programs, including mailbox coordination, timely responses, and prioritization of deliverables.
- Oversee PDE reconciliation activities, identifying trends, variances, and discrepancies to ensure data accuracy and compliance.
- Lead pharmacy outreach initiatives related to CMS disputes, ensuring proper execution and adherence to regulatory requirements.
- Support claims monitoring and escalation resolution by conducting root cause analysis and coordinating cross-functional responses.
- Develop, maintain, and improve operational documentation, including SOPs, policies, job aids, and training materials.
- Participate in validation of system enhancements by reviewing outputs, identifying issues, and recommending improvements.
- Plan and facilitate cross-functional meetings to align stakeholders and drive resolution of operational priorities.
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