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$34K

$107.7K

$179.5K

How much do director medicare operations jobs pay per year?

As of Jul 4, 2026, the average yearly pay for director medicare operations in the United States is $107,680.00, according to ZipRecruiter salary data. Most workers in this role earn between $75,500.00 and $135,500.00 per year, depending on experience, location, and employer.

What are the key skills and qualifications needed to thrive as a Director of Medicare Operations, and why are they important?

To thrive as a Director of Medicare Operations, you need deep knowledge of Medicare regulations, healthcare administration, and operational leadership, often supported by a bachelor's or master's degree in healthcare or business. Familiarity with claims processing systems, CMS guidelines, and data analytics tools is typically required. Strong strategic thinking, problem-solving, and communication skills are essential for leading teams and ensuring regulatory compliance. These skills and qualities are vital for optimizing operational efficiency, maintaining compliance, and driving organizational success in the complex Medicare landscape.

What does a Director of Medicare Operations do?

A Director of Medicare Operations is responsible for overseeing the administration and management of Medicare-related programs within a healthcare organization or insurance company. This role involves ensuring compliance with federal and state regulations, optimizing operational efficiency, and leading teams that handle enrollment, claims processing, and customer service for Medicare members. The director also collaborates with other departments to implement strategic initiatives, improve quality of care, and ensure financial performance. Their leadership helps ensure that Medicare beneficiaries receive timely and accurate services while maintaining the organization's standards and objectives.

How does a Director of Medicare Operations typically collaborate with compliance and clinical teams to ensure regulatory adherence?

A Director of Medicare Operations plays a critical role in bridging operational processes with compliance and clinical teams. They regularly coordinate with compliance officers to interpret and implement CMS regulations, ensuring all processes meet federal standards. Additionally, they work closely with clinical leaders to design workflows that maintain both operational efficiency and high-quality patient care. This collaboration often involves frequent meetings, joint audits, and developing cross-functional training to address any regulatory or quality issues promptly.
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Director Medicare Operations jobs near you
Infographic showing various Director Medicare Operations job openings in the United States as of June 2026, with employment types broken down into 100% Full Time. Highlights an 89% In-person, and 11% Remote job distribution, with an average salary of $107,680 per year, or $51.8 per hour.
Director, Medicare Enrollment and Appeals Group

Director, Medicare Enrollment and Appeals Group

Centers for Medicare & Medicaid Services

Woodlawn, MD • On-site, Remote

$155K - $228K/yr

Full-time

Posted 8 days ago

Job description

Summary
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.
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Duties
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  • 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.

Requirements
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Conditions of employment
  • Must be a U.S. Citizen or National.
  • Subject to a 1-year supervisory probationary period (unless already completed).
  • Complete a Declaration for Federal Employment to determine your suitability for Federal employment, at the time requested by the agency.
  • If you are a male applicant born after December 31, 1959, certify that you have registered with the Selective Service System or are exempt from having to do so.
  • May be subject to pre-employment and random drug tests.
  • You may be required to obtain and maintain an interim and/or final security clearance prior to entrance on duty. Failure to obtain and maintain the required level of clearance may result in the withdrawal of a job offer or removal.
  • The Ethics in Government Act, PL 95-521 requires the applicant selected for this position to submit a financial disclosure statement, OGE-278e, prior to assuming the SES position, annually, and upon termination of employment.
  • Status applicants must submit a copy of their most recent SF-50, Notification of Personnel Action, which verifies status.
  • All initial appointments to an SES position are contingent on approval from OPM's Qualifications Review Board unless the selectee has successfully participated in an OPM approved SES Candidate Development Program.
  • Only experience obtained by the closing date of this announcement will be considered.

Qualifications
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.
Education
This job does not have an education qualification requirement.
Additional information
Veterans Preference: Veterans' preference is not applicable to the SES.
Mobility:Organizational and geographical mobility is essential in developing and managing SES leaders. Individuals selected for SES positions members may be subject to reassignment across geographical, organizational, and functional lines, and may be required to sign a Reassignment Rights and Obligation Agreement.
Equal Employment Opportunity (EEO) Policy Statement: http://www.eeoc.gov/federal/index.cfm
Employment Information Resources - Resource Center: https://help.usajobs.gov/how-to
Males born after 12-31-1959 must be registered or exempt from Selective Service (see https://www.sss.gov/RegVer/wfRegistration.aspx)
OPM must authorize any employment offers made to current or former (within the last 5 years) political Schedule A, Schedule C, or Non-career SES employees in the executive branch. If you are currently, or have been within the last 5 years, a political Schedule A, Schedule C, or Noncareer SES employee in the executive branch, you must disclose that to the Human Resources Office.
Salary for SES positions varies depending on qualifications. The annual salary range is found at the top of this announcement. The selectee for this position may be eligible for annual performance bonuses and performance-based pay adjustments.
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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.
Benefits
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A career with the U.S. government provides employees with a comprehensive benefits package. As a federal employee, you and your family will have access to a range of benefits that are designed to make your federal career very rewarding. Opens in a new windowLearn more about federal benefits.
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Eligibility for benefits depends on the type of position you hold and whether your position is full-time, part-time or intermittent. Contact the hiring agency for more information on the specific benefits offered.

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