Manager, Government Submissions and Risk Analytics
Overview
We are seeking an experienced leader to oversee government data submission operations across multiple healthcare programs. This individual will manage a team responsible for ensuring accurate, timely, and compliant reporting tied to risk adjustment and quality initiatives across Medicare, Medicaid, and commercial exchange populations.
This role combines team leadership, technical oversight, and cross-functional collaboration to support critical regulatory submissions and enterprise data strategies.
Key Responsibilities
- Lead and develop a team responsible for end-to-end government data submission processes, including risk adjustment and quality reporting
- Ensure accuracy, completeness, and compliance of all data submitted to regulatory bodies and external partners
- Partner with internal stakeholders to design and execute scalable reporting and submission strategies aligned with business priorities
- Drive improvements in data workflows, automation, and reporting capabilities to enhance operational efficiency
- Analyze complex healthcare datasets and translate findings into actionable insights for leadership and cross-functional teams
- Collaborate with departments such as finance, actuarial, clinical, and operations to support data-driven decision-making
- Identify and mitigate risks related to data integrity, submission accuracy, and regulatory compliance
- Support strategic planning initiatives related to government programs, including performance improvement efforts
- Oversee hiring, coaching, and ongoing development of team members while fostering a high-performance culture
Qualifications
- 5+ years of experience within healthcare data, government program operations, or related analytical functions
- Prior experience managing or mentoring teams in a data or analytics environment
- Strong familiarity with Medicare Advantage; exposure to Medicaid and ACA programs is a plus
- Hands-on experience working with healthcare data, including encounter or claims-based submissions
- Proficiency in SQL and data visualization/reporting tools (e.g., Power BI or similar platforms)
- Strong analytical mindset with the ability to interpret large datasets and develop strategic recommendations
- Excellent communication skills with the ability to convey technical concepts to non-technical audiences
- Proven ability to manage multiple priorities in a highly regulated, deadline-driven environment
FAQs
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