Government Program Operations Manager
New
Based in the United StatesFull-TimeManager
Salary not disclosed
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Job Details
- Experience
- 5+ years
- Required Skills
- PythonSQLData AnalysisProcess improvementR
Requirements
- 5+ years of experience in healthcare data, operations, or analytics roles
- 5+ years of experience in PBM, health plan, Medicare Part D, Medicaid, or Exchange program environments
- Strong experience working with SQL, R, or Python
- Demonstrated ability to manage multiple complex projects in a fast-paced environment
- Strong understanding of healthcare claims and encounter data
- Experience collaborating across cross-functional teams including compliance, product, and client services
- Excellent written and verbal communication skills
- Proven ability to contribute to process improvement and automation
Responsibilities
- Interpret CMS and state regulatory guidance and translate requirements into operational processes
- Oversee implementation of regulatory changes across systems and workflows
- Monitor operations to identify errors and implement corrective actions
- Support claims correction activities and coordination of benefits (COB)
- Lead internal, client, and government audit preparation and documentation
- Design and implement automated tools for operational efficiency
- Analyze complex encounter and PDE data to identify trends and anomalies
- Define business requirements for system enhancements
- Track key performance metrics for regulatory alignment
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