Director, Medicare Enrollment and Appeals Group

Summary

This position is located in the Center of Medicare, Medicare Enrollment and Appeals Group, Centers for Medicare and Medicaid Services (CMS).

About the Role

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.

Responsibilities

• 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.

Requirements

None specified in the job posting.

Qualifications

• Demonstrated senior-level experience leading complex health care program policy and operations for eligibility, enrollment, and appeals processes for a national or state health care program or large scale health organization in the public and/or private sector.
• Demonstrated executive leadership experience directing highly skilled, multidisciplinary professional staff, managing large budgets, and creative resourcing activities to deliver high-profile initiatives within a national or state health care program or large-scale health care organization.

Benefits

Not specified in the job posting.

Pay

Annual salary range varies depending on qualifications.

Schedule

Not specified in the job posting.