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Operations Analyst, Government Programs (EGWP)

Charlotte, North Carolina, United States; Denver, Colorado, United States; New York, New York, United States

About Judi Health

Judi Health is an enterprise health technology company providing a comprehensive suite of solutions for employers and health plans, including:

  • Judi Rx, a public benefit corporation delivering full-service pharmacy benefit management (PBM) solutions to self-insured employers,
  • Judi Health™, which offers full-service health benefit management solutions to employers, TPAs, and health plans, and
  • Judi®, the industry’s leading proprietary Enterprise Health Platform (EHP), which consolidates all claim administration-related workflows in one scalable, secure platform.

Together with our clients, we’re rebuilding trust in healthcare in the U.S. and deploying the infrastructure we need for the care we deserve. To learn more, visit www.judi.health.

Location: Hybrid (Local to NYC, Denver, CO or Charlotte, NC)

Position Summary:

The Government Programs Operations Analyst (EGWP) provides operational and administrative support to ensure day to day Health Plan activities are performed timely and compliantly.  The role will be responsible for supporting EGWP implementation and the ongoing oversight of  member touchpoint activities with the Medicare part D Prescription Drug Plan (PDP) Employer Group Waiver Plan (EGWP).  This role will perform the day to day functional activities to ensure compliance with the Centers of Medicare and Medicaid (CMS) regulations while meeting employer, member and Health Plan financial objectives.

Position Responsibilities:

  • Support EGWP program setup, implementation and go-live readiness across assigned internal functions and delegate oversight, which includes enrollment, claims processing, member services, member communications, CAHPS activities and associated member service STARs activities.
  • Monitor daily, weekly and monthly performance, operational KPIs and CMS compliance metrics for enrollment, member services, and member communications. 
  • Support with issue resolution and corrective action completion with related, first tier and downstream entities (FDRs).
  • Perform oversight of monthly enrollment audits performed by CMS and semi-annual enrollment reporting.
  • Perform oversight of member services and member communications through call evaluations and random sample review or materials and documentation.
  • Ensure timely and accurate reporting information is received  from both internal and external resources as required by the Health plan.
  • Collaborate with account management and/or employer groups on enrollment issues to be resolved by Employer groups to ensure timeliness and compliance with CMS guidance
  • Develop compliant documentation for operational areas to include policies, procedures, workflows and other work instructions.
  • Support additional functions, as needed.

Required Qualifications:

  • Minimum of HS diploma/GED or equivalent experience
  • 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

Preferred Qualifications

  • Health Plan Medicare Part D and/or EGWPs
  • Experience working within CMS systems, including but not limited to HPMS and MARx.
  • Experience with Federal and State Audits

New York, NY Salary Range

$78,800 - $98,500 USD

Denver, CO Salary Range

$72,000 - $90,000 USD

Charlotte, NC Salary Range

$65,600 - $82,000 USD

All employees are responsible for adherence to the Judi Health Code of Conduct including the reporting of non-compliance. This position description is designed to be flexible, allowing management the opportunity to assign or reassign duties and responsibilities as needed to best meet organizational goals.

We provide equal employment opportunities to all employees and applicants for employment and prohibit discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, medical condition, genetic information, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws. 

By submitting an application, you agree to the retention of your personal data for consideration for a future position at Judi Health. More details about Judi Health's privacy practices can be found at https://www.judi.health/legal/privacy-policy.

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