[Remote] Government Program Operations Manager – Analysis & Efficiencies

Note: The job is a remote job and is open to candidates in USA. Capital Rx is an enterprise health technology company focused on delivering comprehensive pharmacy benefit management solutions. The Government Programs Operations Manager is responsible for overseeing the implementation and compliance of Medicare, Medicaid, and Exchange programs while leading a team to identify and maintain operational efficiencies.ResponsibilitiesInterpret and operationalize CMS/state regulatory and sub-regulatory guidance in collaboration with Compliance and internal SMEsOversee timely implementation of regulatory changes, coordinating cross-functional workplans across impacted departmentsMonitor internal operations for government programs, identify and resolve errors through root cause analysis, and implement corrective actionsSupport claims correction activities related to retro-eligibility and coordination of benefits (COB), while placing focus on the accurate reprocessing of claimsSupport internal, client, and government audits by ensuring data accuracy, process transparency, and documentation completenessDrive team to maintain comprehensive documentation including policies, procedures, job aids, workflows, and reporting specificationsLead the development of automated tools and scalable solutions to improve operational efficiency and data accuracyAnalyze complex encounter and PDE data using internal and external sources to identify trends, outliers, and improvement opportunitiesDefine and document business and reporting requirements to support system enhancements and process improvementsTrack performance metrics for encounter and PDE submissions, ensuring alignment with client and regulatory expectationsPromote subject matter expertise within the team by encouraging proactive process reviews and knowledge sharing for purpose of establishing continuity within the team and its processesResponsible for adherence to the Capital Rx Code of Conduct, including reporting of noncomplianceSkills5+ years of healthcare data experience5+ years of relevant PBM and/or Health Plan experience supporting Medicare Part D, Medicaid, or Exchange plans5+ years of experience working with SQL, R, or PythonExperience working with cross-functional teamsAbility to balance multiple complex projects simultaneouslyExtremely flexible, highly organized, and able to shift priorities easilyAttention to detail & commitment to delivering high quality work productFlexibility to respond to a range of different work situationsExcellent written and verbal communication skillsAbility to foster a culture of collaboration and high performing teamCompany OverviewCapital Rx is now Judi Health! Navigate to our new page here: https://www.linkedin.com/company/judi-health It was founded in 2017, and is headquartered in New York, New York, USA, with a workforce of 501-1000 employees. Its website is https://www.judi.health.