Director, Medicare Enrollment and Appeals Group
What you'd do
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.
Major duties
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.
What you need to qualify
Candidates should be committed to improving the efficiency of the Federal government, passionate about the ideals of our American republic, and committed to upholding the rule of law and the United States Constitution. Candidates will not be hired based on their race, sex, color, religion, or national origin. To meet the minimum qualification requirements for this position, you must show that you possess the Executive Core Qualifications (ECQs) and Technical Qualifications (TQs) related to this position within your resume - NOT TO EXCEED 2 PAGES. Resumes over the 2-page limit will not be reviewed beyond page 2 or may be disqualified. Your resume should include examples of experience, education, and accomplishments applicable to the ECQ's and TQ's. If your resume does not reflect demonstrated evidence of these qualifications, you may not receive consideration for the position. There is NO requirement to prepare a narrative statement specifically addressing the Executive Core Qualifications (ECQs) or the Technical Qualifications (TQs). TECHNICAL QUALIFICATIONS (TQs): Your resume should demonstrate accomplishments that would satisfy the technical qualifications. TQ 1: 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. TQ 2: Demonstrated executive leadership experience directing highly skilled, multidisciplinary professional staff, managing large budgets, and creative resourcing activities to delivery high-profile initiatives within a national or state health care program or large-scale health care organization. EXECUTIVE CORE QUALIFICATIONS (ECQs): In addition to the Technical Qualification Requirements listed above, all new entrants into the Senior Executive Service (SES) under a career appointment will be assessed for executive competency against the following five mandatory ECQs. If your 2-page resume does not reflect demonstrated evidence of the ECQs and TQs, you may not receive further consideration for the position. There are five ECQs: ECQ 1: Commitment to the Rule of Law and the Principles of the American Founding - This core qualification requires a demonstrated knowledge of the American system of government, commitment to uphold the Constitution and the rule of law, and commitment to serve the American people. ECQ 2: Driving Efficiency - This core qualification involves the demonstrated ability to strategically and efficiently manage resources, budget effectively, cut wasteful spending, and pursue efficiency through process and technological upgrades. ECQ 3: Merit and Competence - This core qualification involves the demonstrated knowledge, ability, and technical competence to effectively and reliably produce work that is of exceptional quality. ECQ 4: Leading People - This core qualification involves the demonstrated ability to lead and inspire a group toward meeting the organization's vision, mission, and goals, and to drive a high-performance, high-accountability culture. This includes, when necessary, the ability to lead people through change and to hold individuals accountable. ECQ 5: Achieving Results - This core qualification involves the demonstrated ability to achieve both individual and organizational results, and to align results to stated goals from superiors. Note: If you are a member of the SES or have been certified through successful participation in an OPM approved SES Candidate Development Program (SESCDP), or have SES reinstatement eligibility, you do not need to respond to the ECQs. Instead, you should attach proof (e.g., SF-50, Certification by OPM's SES Qualifications Review Board (QRB)) of your eligibility for noncompetitive appointment to the SES.
Before you apply
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