at Blue Cross Blue Shield of Kansas in Topeka, Kansas, United States
Job Description
The Manager, Medicare Programs Operations is responsible for the day-to-day operational oversight of government-sponsored health insurance programs, such as Medicare Advantage (MA), Medicare Supplement (MS) and Prescription Drug Plans (PDP). This role ensures operational excellence, regulatory compliance, and effective vendor and interdepartmental coordination. The manager will drive performance across enrollment, claims, customer service, and other functional areas, while ensuring adherence to CMS requirements and company policies.
What you’ll do
- Accountable for performance monitoring, policy enforcement, termination process, disciplinary action, hiring, compliance and team development. Maintaining accurate records of all hiring, firing and disciplinary actions.
- Oversee day-to-day operations of the MA, MS, and PDP lines of business, including sales, marketing, enrollment/membership, finance, provider network, claims, medical management, customer service, appeals & grievances.
- Ensure operational compliance with CMS regulations and internal policies, to include annual changes in regulation.
- Analyze market trends and understand environmental pressures to help inform decisions and goals in the Medicare market.
- Maintain operational documentation, including SOPs and management controls for government programs.
- Directly liaise with federal regulators and ensure implementation of compliant processes.
- Manage vendors supporting our Medicare programs, to include monitoring vendor performance to ensure contractual obligations and CMS standards are met.
- Work in collaboration with compliance to address external vendors or internal partners when CMS metrics are not being met.
- Participate in audits and CMS evaluations, ensuring annual readiness and timely issue resolution.
- Coordinate with internal teams such as sales, marketing, customer service, finance, provider relations, medical management and compliance to support operational goals.
- Assist in development of strategic goals and alignment of those to the planning and execution of operational goals.
- Develop and manage the MA operational budget.
Knowledge/Skills/Abilities
- Strong leadership, analytical, and communication skills.
- Ability to drive cross-functional collaboration.
- Deep understanding of Medicare operations and compliance standards.
- Strategic thinking with ability to implement practical solutions.
What you need
- Bachelor's degree, preferably in Business Administration, Economics or Public Health. In lieu of a degree, 3 years in the health care delivery industry.
- 3 years of leadership experience.
- Extensive knowledge of Medicare Advantage and Prescription Drug Plan regulations.
- Preferred: Experience with operations, CMS policy interpretation, and government relations.
