Job Description
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.