Director, Enrollment Operations(Duals Special Needs Enrollment Experience Required)

CareSource•Dayton, OH

2d•$113,000 - $197,700•Onsite

About The Position

The Director, Enrollment Operations provides strategic and operational leadership for enterprise enrollment operations across assigned product lines. This role oversees end-to-end member enrollment operations, data integrity, platform integration, vendor coordination, and regulatory compliance across CMS, state Medicaid agencies, internal systems, and external partners.

Requirements

Bachelor's degree in accounting, finance, healthcare management or related field required
Equivalent years of relevant work experience may be accepted in lieu of required education
Seven (7) years of leadership and management experience required
Five (5) years of business operations or similar experience is, preferably in a health care environment, required
Medicaid managed care, Medicare Advantage, Dual Special Needs Plan (D-SNP), or related healthcare experience required
Demonstrated experience leading system integrations, mergers, or operational transformations
Deep knowledge of enrollment operations, CMS regulations, Medicaid processes, and healthcare operational workflows
Proven ability to design and operationalize enterprise oversight frameworks, including dashboards and reconciliation models
Familiarity with healthcare systems such as TriZetto EAM, Facets, MARx, HPMS, and MMIS platforms
Strong knowledge of compliance, audit, and regulatory frameworks, including internal and external controls
Ability to develop long-term enrollment strategy and execute near-term initiatives
Strong analytical and problem-solving skills with the ability to manage competing priorities and timelines
Demonstrated leadership capability, including team development, engagement, and performance management
Ability to effectively interact with all levels of management
Advanced computer skills, including Microsoft Office; ability to learn new technologies quickly
Strong interpersonal, written, and verbal communication skills, including change management capabilities

Nice To Haves

Master of Business Administration (MBA) or other related post-graduate degree preferred
General understanding of IT environments preferred

Responsibilities

Lead end-to-end enrollment operations across markets, including lifecycle activities (prospective enrollment, auto-enrollment, disenrollment, reinstatement), ensuring accuracy, timeliness, and SLA adherence.
Lead integration of enrollment operations for newly acquired or merging health plans, including system alignment, data migration, and process standardization.
Establish and lead an enterprise enrollment oversight framework, including reconciliation methodologies, cross-system validation, and executive reporting to ensure data integrity across internal systems, CMS platforms, and state MMIS systems (e.g., Facets, MARx, HPMS).
Establish and execute enrollment operations strategy aligned with product line growth, regulatory requirements, and market expansion.
Partner with IT to define system enhancements, data governance, and integration strategies supporting scalability and compliance.
Manage vendor relationships and enrollment partners, ensuring SLA performance and timely resolution of enrollment exceptions.
Drive transformation initiatives, including automation, AI-enabled reconciliation, and process optimization.
Monitor KPIs and operational metrics to identify risks, compliance gaps, trends, and improvement opportunities.
Lead, develop, and manage high-performing enrollment operations teams.
Accountable for enrollment, regulatory compliance, financial, and vendor reconciliation activities across assigned lines of business.
Ensure compliance with CMS, Medicaid, and state regulations by leading audit readiness, audit responses, legislative monitoring, and corrective action plans.
Manage CMS 834/820 transactions, state data feeds, and reconciliation processes to ensure accuracy and timeliness.
Establish and enforce enrollment policies, procedures, and internal controls.
Perform any other job related duties as requested.