Manager of Government Submissions

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.

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.

By providing your phone number, you consent to: (1) receive automated text messages and calls from the Judge Group, Inc. and its affiliates (collectively "Judge") to such phone number regarding job opportunities, your job application, and for other related purposes. Message & data rates apply and message frequency may vary. Consistent with Judge's Privacy Policy, information obtained from your consent will not be shared with third parties for marketing/promotional purposes. Reply STOP to opt out of receiving telephone calls and text messages from Judge and HELP for help.