Manager, Enrollment Operations (Health Plan Enrollment experience required)

About the role

The Manager, Enrollment Operations provides leadership and direction to the Enrollment team to ensure the goals and standards of the department, and CareSource, are met. General office environment; may be required to sit or stand for extended periods of time. Travel is not typically required.

Responsibilities

• Understand enrollment end to end processes and able to comprehend impact of any enrollment issues to various departments in the organization
• Responsible for quality of outputs and operational efficiency of the team
• Responsible for managing staff to ensure timely, accurate and high quality completion of service items for internal customers
• Oversee the financial and member enrollment reconciliation for assigned lines of business
• Oversee vendor eligibility extract processes to ensure accurate and timely processing of eligibility data
• Responsible for complying with and meeting all regulatory requirements assigned to their team
• Manage enrollment technology and process analysts and associated activities involving 834 or Daily Translation Reply Report (DTRR) file processes and departmental P&P’s
• Manage all enrollment audit engagements to ensure accurate and timely response. As necessary, develop and implement corrective action plans to address audit results
• Gather, analyze, and report data related to the performance of the department and make recommendations for process improvement(s)
• Actively participate in ongoing development of new products and technologies
• Manage daily operations and projects through effective allocation of resources
• Develop and maintain an in-depth knowledge of the company’s business and regulatory environments
• Incorporate effective change and risk management controls
• Responsible for hiring, training, coaching and developing direct reports including completing performance appraisals and disciplinary actions
• Mentor team leads and team members to produce consistent, high quality deliverables
• Performs any other job related duties as requested.

Qualifications

• Bachelor's degree required
• Equivalent years of relevant work experience may be accepted in lieu of required education
• Three (3) years of leadership/management experience required
• Three (3) years of enrollment/reconciliation/call center experience required

Licensure and Certification: None required

Skills

• Strong understanding of health plan enrollment processes
• Expert proficiency in Facets subscriber and member setup, benefits eligibility [including COB], and proficiency in the Customer Service application is preferred
• Knowledge of Medicaid, Medicare, and Dual coverage programs, including enrollment requirements and regulatory compliance
• Understanding of HIPAA 834, EDI 270/271, DTRR, MMR, and other industry-standard enrollment files and data exchange processes
• Knowledge of enrollment reconciliation is preferred
• Strong knowledge of regulatory reporting and compliance requirements is preferred
• Proficient in use of online services to verify member eligibility for each CareSource program, and internal and external eligibility search functions
• Effective people management/leadership skills
• Strong knowledge of database management desired
• Knowledge of working with IT teams and providing requirements
• Ability to effectively prioritize and execute tasks in