About the Role
The Manager of Government Submissions leads a high-performing team responsible for regulatory data submissions across our Medicare, Medicaid, and Affordable Care Act (ACA) programs. In this role, you will drive data-driven initiatives for risk adjustment and quality programs while mentoring a diverse team of business and data analysts.
You will serve as a key bridge between technical data operations and strategic business objectives, coordinating with multiple stakeholders-including vendors, third-party entities, and government bodies (CMS, HHS, DHS)-to ensure the accurate, complete, and truthful submission of critical healthcare data.
OUR CLIENT CAN ONLY SUPPORT CANDIDATES FROM THESE STATES:
Arizona, Arkansas, Florida, Georgia, Idaho, Indiana, Iowa, Kansas, Kentucky, Michigan, Minnesota, Missouri, Nevada, New Hampshire, North Carolina, North Dakota, Ohio, Oklahoma, Pennsylvania, Tennessee, Texas, Utah, Vermont, Virginia, Wisconsin
Responsibilities
- Strategic Leadership: Develop and provide strategic direction for the team managing day-to-day data submissions for ACA, Medicare, and Medicaid risk adjustment and quality programs.
- Process Automation: Oversee the development and automation of business and reporting strategies, partnering with stakeholders to ensure technical designs align with corporate objectives.
- Data Analysis & Interpretation: Direct the research and analysis of risk adjustment data; provide technical guidance to Finance, Underwriting, Legal, and Senior Leadership.
- Stakeholder Communication: Synthesize complex data findings into clear, compelling narratives to support executive decision-making and stakeholder alignment.
- Integrity & Compliance: Maintain robust processes to assess and prevent data loss; ensure all submissions meet rigorous federal and state regulatory standards.
- Planning & Performance: Participate in strategic planning for risk adjustment initiatives; lead department hiring, training, performance evaluations, and career development for a team of 7-10 employees.
Minimum Qualifications
- 5+ years of professional experience in healthcare government submissions or data management.
- 3+ years of direct people management experience.
- Technical Proficiency: Expert-level knowledge of SQL Server (including SSIS/SSRS) and data visualization tools (e.g., Power BI).
- Domain Expertise: Excellent knowledge of Medicare Advantage and/or the ACA marketplace, including a strong understanding of CMS initiatives.
- Communication: Proven ability to translate complex technical concepts and issues for non-technical audiences.
- Education: High school diploma or equivalency and legal authorization to work in the U.S.
Preferred Qualifications
- Education: Bachelor's degree in Finance, Mathematics, Computer Science, Data Science, or Health Science.
- Specialized Experience: Background leading Risk Adjustment submission teams at health insurance carriers, providers, or healthcare consulting firms.
- Audit & Quality: Experience supporting RADV audits and HEDIS data collection/submissions.
- Advanced Analytics: Knowledge of statistical software such as R or SAS.
- Industry Knowledge: Hands-on experience with encounter data submissions and deep familiarity with encounter claims data.
- Leadership: 5+ years of experience managing high-functioning analytical teams.
About the Role
The Manager of Government Submissions leads a high-performing team responsible for regulatory data submissions across our Medicare, Medicaid, and Affordable Care Act (ACA) programs. In this role, you will drive data-driven initiatives for risk adjustment and quality programs while mentoring a diverse team of business and data analysts.
You will serve as a key bridge between technical data operations and strategic business objectives, coordinating with multiple stakeholders-including vendors, third-party entities, and government bodies (CMS, HHS, DHS)-to ensure the accurate, complete, and truthful submission of critical healthcare data.
OUR CLIENT CAN ONLY SUPPORT CANDIDATES FROM THESE STATES:
Arizona, Arkansas, Florida, Georgia, Idaho, Indiana, Iowa, Kansas, Kentucky, Michigan, Minnesota, Missouri, Nevada, New Hampshire, North Carolina, North Dakota, Ohio, Oklahoma, Pennsylvania, Tennessee, Texas, Utah, Vermont, Virginia, Wisconsin
Responsibilities
- Strategic Leadership: Develop and provide strategic direction for the team managing day-to-day data submissions for ACA, Medicare, and Medicaid risk adjustment and quality programs.
- Process Automation: Oversee the development and automation of business and reporting strategies, partnering with stakeholders to ensure technical designs align with corporate objectives.
- Data Analysis & Interpretation: Direct the research and analysis of risk adjustment data; provide technical guidance to Finance, Underwriting, Legal, and Senior Leadership.
- Stakeholder Communication: Synthesize complex data findings into clear, compelling narratives to support executive decision-making and stakeholder alignment.
- Integrity & Compliance: Maintain robust processes to assess and prevent data loss; ensure all submissions meet rigorous federal and state regulatory standards.
- Planning & Performance: Participate in strategic planning for risk adjustment initiatives; lead department hiring, training, performance evaluations, and career development for a team of 7-10 employees.
Minimum Qualifications
- 5+ years of professional experience in healthcare government submissions or data management.
- 3+ years of direct people management experience.
- Technical Proficiency: Expert-level knowledge of SQL Server (including SSIS/SSRS) and data visualization tools (e.g., Power BI).
- Domain Expertise: Excellent knowledge of Medicare Advantage and/or the ACA marketplace, including a strong understanding of CMS initiatives.
- Communication: Proven ability to translate complex technical concepts and issues for non-technical audiences.
- Education: High school diploma or equivalency and legal authorization to work in the U.S.
Preferred Qualifications
- Education: Bachelor's degree in Finance, Mathematics, Computer Science, Data Science, or Health Science.
- Specialized Experience: Background leading Risk Adjustment submission teams at health insurance carriers, providers, or healthcare consulting firms.
- Audit & Quality: Experience supporting RADV audits and HEDIS data collection/submissions.
- Advanced Analytics: Knowledge of statistical software such as R or SAS.
- Industry Knowledge: Hands-on experience with encounter data submissions and deep familiarity with encounter claims data.
- Leadership: 5+ years of experience managing high-functioning analytical teams.
