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Medicare Operations Manager Jobs in Minnesota (NOW HIRING)

Ra

Health Care Analyst (Medicare)

Minneapolis, MN · Remote

You will be understanding the strategic direction set by senior management as it relates to team ... Who holds 2+ years' experience in US Payer operations & US Payer system implementations! Who is ...

Medix

Licensed Medicare Agent

Saint Paul, MN · On-site

$24.04 - $26.44/hr

Document and update client information in CRM * Manage inbound calls and voicemail follow-up from a ... Due to these job duties, this position has a significant impact on the business operations and ...

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All JobsMedicare Operations JobsMedicare Operations Manager JobsMedicare Operations Manager Jobs in Minnesota

Medicare Operations Manager information

See Minnesota salary details

$30.4K

$62.1K

$116.1K

How much do medicare operations manager jobs pay per year?

As of Aug 5, 2026, the average yearly pay for medicare operations manager in Minnesota is $62,150.00, according to ZipRecruiter salary data. Most workers in this role earn between $40,200.00 and $75,900.00 per year, depending on experience, location, and employer.

What is the difference between Medicare Operations Manager vs Medicare Claims Supervisor?

AspectMedicare Operations ManagerMedicare Claims Supervisor
Required CredentialsBachelor's degree in healthcare administration or related field; certifications like CPC or CMS certificationsHigh school diploma or associate's; certifications like CPC or claims-specific training
Work EnvironmentOversees multiple departments, manages staff, and ensures compliance in healthcare organizationsSupervises claims processing teams, reviews claims, and ensures accuracy in claims submission
Employer & Industry UsageHealth insurance companies, Medicare administrative contractors, healthcare providersHealth insurance companies, Medicare contractors, claims processing centers

The Medicare Operations Manager focuses on overseeing overall Medicare operations, including compliance and staff management, while the Medicare Claims Supervisor concentrates on managing claims processing and accuracy. Both roles require knowledge of Medicare policies and certifications like CPC, but differ in scope and responsibilities.

What are the key skills and qualifications needed to thrive as a Medicare Operations Manager?

To thrive as a Medicare Operations Manager, you need expertise in healthcare administration, Medicare regulations, and process optimization, typically supported by a bachelor's degree in healthcare or business administration. Familiarity with CMS guidelines, claims processing systems, and compliance management tools is essential. Strong leadership, analytical thinking, and effective communication distinguish top performers in this role. These skills are crucial for ensuring regulatory compliance, operational efficiency, and high-quality service in the management of Medicare programs.

What are some of the main challenges faced by a Medicare Operations Manager, and how can they be addressed?

A Medicare Operations Manager often encounters challenges such as staying current with frequently changing CMS regulations, ensuring data accuracy, and coordinating across multiple departments to maintain compliance and operational efficiency. Addressing these challenges involves maintaining robust communication channels, investing in ongoing staff training, and leveraging technology to automate reporting and auditing processes. Building strong relationships with compliance, IT, and customer service teams also helps streamline workflows and foster a proactive approach to problem-solving.

What is a Medicare Operations Manager?

Medicare Operations Managers are professionals responsible for overseeing the daily operations of Medicare-related services within healthcare organizations or insurance companies. They ensure compliance with federal regulations, manage teams that process Medicare claims, and work to optimize workflows and efficiency. Their role also involves monitoring performance, implementing policy changes, and coordinating with other departments to ensure high-quality service for Medicare beneficiaries. These managers play a critical role in maintaining regulatory standards and improving overall operational effectiveness.
What are popular job titles related to Medicare Operations Manager jobs in Minnesota? For Medicare Operations Manager jobs in Minnesota, the most frequently searched job titles are:
What job categories do people searching Medicare Operations Manager jobs in Minnesota look for? The top searched job categories for Medicare Operations Manager jobs in Minnesota are:
What cities in Minnesota are hiring for Medicare Operations Manager jobs? Cities in Minnesota with the most Medicare Operations Manager job openings:
Medicare Operations Manager jobs near you

Appeals and Grievances - RN, Consultant (MediCare)

Blue Shield of CA

Minneapolis, MN • On-site

Other

This job post has expired today. Applications are no longer accepted.

Job description

Your Role

The Medicare Appeals and Grievances team is responsible for clinically reviewing member appeals and grievances that are the result of either a preservice, post service or claim denial. The Medicare Appeals and Grievances RN Lead will report to the Appeals and Grievances Manger. In this role you will be leading a team of nurses who will be responsible for performing first level appeal reviews for members utilizing the National Coverage Determination (NCD) guidelines, Local Coverage Determination (LCD) Guidelines, and nationally recognized sources such as MCG, NCCN, and ACOG. Reviews will also be performed for medical necessity and to meet the criteria for the coding billed. You will also be responsible for quality audits, inventory management and reviews of department work process documents. The ideal candidate will have previous leadership experience, hold an active CA license from Board of Registered Nurses and higher-level certifications are highly desirable.

Our leadership model is about developing great leaders at all levels and creating opportunities for our people to grow - personally, professionally, and financially. We are looking for leaders that are energized by creative and critical thinking, building and sustaining high-performing teams, getting results the right way, and fostering continuous learning.

Your Knowledge and Experience

  • Bachelor of Science in Nursing or advanced degree preferred
  • Requires a current California RN License
  • Requires at least 7 years of prior relevant experience
  • Requires independent motivation, a strong work ethic, and strong computer navigation skills
  • Requires familiarity with electronic health record (EHR) systems
  • At least 2 years of Supervisory and/or leadership experience preferred
  • General knowledge of claims processing logic/rules
  • Comprehensive knowledge of Medicare required
  • Comprehensive knowledge of health plan operations, regulatory agencies and state/federal regulations related to health care.

Hybrid Virtual Work

This role allows employees to work virtually full-time, however employees will be expected to come into the office based on business need.

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