Enrollment Coordinator Team Lead - Human Services Program Representative 2

About the role

This position provides lead work direction and training for Medicare enrollment coordinator staff assigned to the Medicare enrollment team. It also executes proper compliance and auditing requirements to meet state and federal regulations and third party administrator (TPA) contractual obligations.

Responsibilities

• Track and evaluate the TPA unit's progress and outcomes.
• Design and review materials for distribution.
• Evaluate member enrollment and education policies, processes, procedures, and/or forms/publications.
• Monitor performance indicators and outcomes for the Medicare enrollment coordinators.
• Recommend interventions, modifications, and enhancements needed to ensure compliance with law, contract provisions, and legislative intent.
• Ensure potential members receive unbiased information regarding Managed Care information related to MN Senior Health Options (MSHO) and Special Needs Basic Care (SNBC) integrated products and their health plan selection options.
• Evaluate DHS system/technical supports meeting the TPA unit, managed care organizations (MCOs), and county needs.
• Enroll eligible managed care members in a timely, accurate manner to ensure appropriate payment and compliance with federal/state regulations.
• Act as a major contact point for resolving problems relating to enrollment operations, enrollment policies and practices, and MMIS functions.
• Research, facilitate, and ensure resolution of enrollment entry problems.
• Research and respond to policy and procedure inquiries associated with enrollment and education.
• Take part in future planning, development, and evaluation as it relates to the implementation of and systems supports for new purchasing strategy initiatives in the form of pilot projects, innovative contract options, and new legislative mandates.

  Requirements

  • Advanced level knowledge and experience with the MN Senior Health Option (MSHO) and Special Needs Basic Care (SNBC) programs, state and federal managed care policies & regulations, and Medicare enrollment/dis-enrollment requirements applicable to special needs plans.
  • Advanced level knowledge with health care compliance, Medicare auditing procedures, data collection, data manipulation, and data interpretation.
  • Bachelor's degree or higher degree in human services, business, healthcare or related field may substitute one year of professional experience.
  • Ability to perform effectively and set and manage priorities under the normal situation of demanding deadlines and continuously fluctuating regulations and organizational relationships.
  • Strong communication skills, including the oral and written presentation of research results.
  • Ability to translate technical language and concepts for management and policy staff as well as translate programs and policies into technical language for systems staff.
  • Understanding of federal and state mandates which have impacts on managed care contracts.
  • Extensive experience using SQL, SAS or other language to query relational databases.
  • Familiarity with office software, particularly Microsoft Excel.
  • Variety of experiences working effectively with others from different backgrounds and cultures.

  Qualifications

  • Three years of working with Health Care Programs and Managed Care Policy demonstrating the above qualifications.

  Skills

  • Advanced knowledge of MN Senior Health Option (MSHO) and Special Needs Basic Care (SNBC) programs.
  • Advanced knowledge with health care compliance, Medicare auditing procedures, data collection, data manipulation, and data interpretation.
  • Experience using SQL, SAS or other language to query relational databases.
  • Familiarity with office software, particularly Microsoft Excel.
  • Effective communication and translation skills.
  • Ability to work effectively with diverse groups.

  Benefits

  • Paid vacation and sick leave.
  • 12 paid holidays each year.
  • Low-cost medical, dental, vision, and prescription drug plans.
  • Fertility care, including IVF.
  • Dental and orthodontic care for adults and children.
  • 6 weeks paid leave for parents of newborn or newly adopted children.
  • Pension plan that provides income when you retire (after working at least three years).
  • Employer paid life insurance to provide support for your family in the event of death.
  • Short-term and long-term disability insurance that can provide income if you are unable to work due to illness or injury.
  • Tax-free expense accounts for health, dental, and dependent care.