Director, Medicare Enrollment and Appeals Group

Principal Advisor For Medicare

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.