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Director, Medicare Enrollment and Appeals Group
Centers for Medicare & Medicaid Services · Posted 98 days ago
About the Role
This position is located in the Center of Medicare, Medicare Enrollment and Appeals Group, Centers for Medicare and Medicaid Services (CMS). As the Director, Medicare Enrollment and Appeals Group, you will provide executive leadership for a comprehensive program to develop and implement national policies and procedures of enrollment and disenrollment for both Original Medicare and the Part D and MA programs, claims-related hearing, appeals, and grievances processes for all Medicare Parts.
What You'll Do
- →Serves as the principal advisor to CMS leadership on Medicare eligibility, enrollment, entitlement, appeals, grievances, and dispute resolution policies for Medicare Parts A, B, C, and D.
- →Directs and oversees all functions of the Medicare Enrollment and Appeals Group (MEAG), establishing strategic goals, managing operations, evaluating performance, and resolving complex policy and operational issues.
- →Promotes quality management principles, including teamwork, customer focus, employee engagement, continuous improvement, and beneficiary-centered service delivery.
- →Oversees implementation and administration of Medicare statutory requirements, including Limitation on Liability, physician refund requirements, and medical equipment and supplies beneficiary protections.
- →Directs the development, evaluation, and issuance of regulations, guidance, operational instructions, and manuals governing Medicare appeals, grievances, enrollment, entitlement, and late enrollment penalties.
- →Provides national policy leadership and operational direction to CMS components, Medicare contractors, Medicare Advantage (MA) organizations, Prescription Drug Plans (PDPs), and other key Medicare stakeholders.
- →Directs operational policy, business requirements, systems validation, and maintenance activities for the Enrollment Database (EDB) and Medicare Beneficiary Database (MBD).
- →Develops national policy and oversees operations for the Medicare Part D Low-Income Subsidy (LIS) program, including auto-enrollment, LI-NET, reassignment processes, and beneficiary outreach.
- →Oversees contracts and performance of external review entities and Qualified Independent Contractors (QICs), ensuring policy compliance, operational effectiveness, and quality assurance.
- →Maintains strategic partnerships with CMS components, contractors, plans, advocacy organizations, and other stakeholders to support effective implementation of Medicare enrollment and appeals programs.
- →Directs and coordinates policy implementation with the Social Security Administration, Railroad Retirement Board (RRB), Office of Medicare Hearings and Appeals (OMHA), and the Departmental Appeals Board.
Personality Fit
Job ID: 05200376-434c-4d17-8b38-956f845b54d6
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