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Medicare Operations Manager Jobs in Washington (NOW HIRING)

UNISSANT

Senior DevOps Engineer

Washington, DC · On-site

$147K - $189K/yr

... Medicare and Medicaid Services (CMS) client. An ideal candidate will work with agile teams in a ... Participate in incident management, root cause analysis, problem management, and operational ...

Sagility LLC

Longview Site Lead

Washington, DC · On-site

Experience in operations management within a Medicare Advantage member acquisition or retention environment * Proven leadership and team management skills with emphasis on mentorship and professional ...

Analytica

Project Manager

Washington, DC · Remote

... Medicare & Medicaid Services (CMS) program. The PM will be responsible for overall contract ... Ensure analytical outputs support CMS program integrity objectives and operational decision-making.

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Medicare Operations Manager information

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 Washington? For Medicare Operations Manager jobs in Washington, the most frequently searched job titles are:
What job categories do people searching Medicare Operations Manager jobs in Washington look for? The top searched job categories for Medicare Operations Manager jobs in Washington are:
What cities in Washington are hiring for Medicare Operations Manager jobs? Cities in Washington with the most Medicare Operations Manager job openings:
Medicare Operations Manager jobs near you
Infographic showing various Medicare Operations Manager job openings in Washington as of August 2026, with employment types broken down into 83% Full Time, 14% Part Time, 1% Temporary, and 2% Contract. Highlights an 94% Physical, 2% Hybrid, and 4% Remote job distribution.

Lead Director, Credentialing Operations

Hispanic Alliance for Career Enhancement

Annapolis, MD • On-site

$100 - $232/hr

Other

Medical, Dental, Vision, Retirement, PTO

Posted 6 days ago

Job description

We\'re building a world of health around every individual - shaping a more connected, convenient and compassionate health experience. At CVS Health®, you\'ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger - helping to simplify health care one person, one family and one community at a time.

Position Summary

The Lead Director, Credentialing Operations oversees the Credentialing Verification Organization (CVO) and is accountable for the overall delivery of credentialing services including production, quality audit, reporting, ongoing monitoring and process improvement for the business operation. Maintain and validate the credentialing data for all network providers for multiple lines of business. Ensure all provider information is accurately recorded and maintained to provide a compliant and quality network of providers who are treating Aetna members. Aligns policies and procedures for the Credentialing Operations department with organizational goals. Delivers on financial, operational, and service requirements while providing leadership and direction through multiple managers and vendors, by developing priorities and setting direction.

Key Responsibilities
  • Oversee operational management of Commercial, Medicare, Medicaid credentialing operations, as well as ongoing monitoring of all providers.
  • Manage a team of ~100 employees through multiple managers.
  • Oversee on-shore and off-shore vendor support tied to business operations to align resources to support inventory management and provide oversight of partner performance through quality and timeliness initiatives.
  • Contribute to planning and administration of company programs and initiatives that promote the Credentialing Operations agenda.
  • Accountable for department initiatives and objectives in partnership with stakeholders and leadership.
  • Implement organizational policies, goals, and objectives based on best practices in the field.
  • Build and develop strong functional operations management team through formal training, diverse assignments, coaching, communication, mentoring and performance management, and mentor team members to foster talent strategy and succession planning.
  • Cultivate and manage relationships with various internal business partners.
  • Ensure all Credentialing policies and procedures are executed consistently across the business operation and support alignment with accreditation agencies and regulatory bodies.
  • Administer audit procedures for maintaining accurate and compliant provider credentialing data for contractual compliance, and network directory listing purposes.

Experience with exploring solutions with automation, bots, AI, and other tools to drive exceptional performance in a highly visible operational environment.

Create and deliver process improvement strategies to address internal trends and meet organizational vision and commitments on an ongoing basis.

Drive change management through the organization to support competitive and changing environment.

  • Lead integration and administration of credentialing databases, software, and other data sources and create strategies for continuous improvement.
  • Control resources to deliver financial results and objectives within established budget parameters.
Required Qualifications
  • 7+ years directly related experience in Healthcare Operations with a production focus
  • Adept at execution and delivery (planning, delivering, and supporting) skills
  • Advance working knowledge of business systems, applications, and tools supporting credentialing, provider data and inventory management.
  • Proven ability to work collaboratively at all levels.
  • Ability to effect change.
  • Exercises sound judgment and demonstrates analytical/data-driven decision-making skills.
Preferred Qualifications
  • Experience in a matrixed environment which includes outsourcing to external vendors.
  • Project management experience.
Education
  • Bachelor\'s degree or equivalent work experience
Pay Range

The typical pay range for this role is:

$100,000.00 - $231,540.00

This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above. This position also includes an award target in the company\'s equity award program.

Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong.

Great benefits for great people

We take pride in offering a comprehensive and competitive mix of pay and benefits that reflects our commitment to our colleagues and their families.

This full‑time position is eligible for a comprehensive benefits package designed to support the physical, emotional, and financial well‑being of colleagues and their families. The benefits for this position include medical, dental, and vision coverage, paid time off, retirement savings options, wellness programs, and other resources, based on eligibility.

Additional details about available benefits are provided during the application process and on Benefits Moments.

We anticipate the application window for this opening will close on: 08/15/2026

Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.

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