About Judi Health
Judi Health is an enterprise health technology company providing a comprehensive suite of solutions for employers and health plans, including:
- Capital 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.
Position Summary
The Government Programs Operations Manager is responsible for overseeing the implementation, compliance, and optimization of Medicare, Medicaid, and Exchange programs. This position blends regulatory expertise with operational innovation to ensure that government program operations are both compliant and technically efficient. This manager will lead a team dedicated to identifying, developing, and maintaining technical analysis and efficiencies across the department. The role involves designing automated solutions, validating the accuracy of deliverables, and interpreting CMS and state guidance to ensure system capabilities align with regulatory intent and client needs.
Position Responsibilities
- Interpret and operationalize CMS/state regulatory and sub-regulatory guidance in collaboration with Compliance and internal SMEs.
- Oversee timely implementation of regulatory changes, coordinating cross-functional workplans across impacted departments.
- Monitor internal operations for government programs, identify and resolve errors through root cause analysis, and implement corrective actions.
- Support claims correction activities related to retro-eligibility and coordination of benefits (COB), focusing on accurate claims reprocessing.
- Support internal, client, and government audits by ensuring data accuracy, process transparency, and documentation completeness.
- Drive the team to maintain comprehensive documentation including policies, procedures, job aids, workflows, and reporting specifications.
- Lead the development of automated tools and scalable solutions to improve operational efficiency and data accuracy.
- Analyze complex encounter and PDE data using internal and external sources to identify trends, outliers, and improvement opportunities.
- Define and document business and reporting requirements to support system enhancements and process improvements.
- Track performance metrics for encounter and PDE submissions, ensuring alignment with client and regulatory expectations.