Director; Enrollment

Sentara Health•Virginia Beach, VA

21h

About The Position

The Director of Enrollment is responsible for operational outcomes of the enrollment and billing teams for assigned lines of business (e.g. Medicare, Medicaid, Commercial). Incumbent will act as subject matter expert for the Enrollment and Billing functions of the Operations organization. The incumbent will facilitate the development of enrollment operations on new lines of business and will ensure successful implementations.

Requirements

Core Enrollment & Billing Expertise
Deep 834 fluency (not just awareness)
Inbound/outbound file structures, reconciliation, error handling, and retroactivity
Experience with trading partners, clearinghouses, and CMS/state interfaces
Strong understanding of: Eligibility life cycle (prospective → active → retro → term), Premium billing (direct bill, group, subsidy interactions), Coordination with claims (impact of eligibility errors → downstream rework)
Hands-on experience with at least one: Medicare DSNP, Medicaid (state-specific nuances), Commercial (ASO + fully insured)
Working knowledge of: CMS enrollment guidance, MARx, TRR processing (for Medicare), State Medicaid eligibility feeds and reconciliation processes
Ability to translate regulation to operations to system configuration
Experience with core admin platforms (examples to probe for depth, not just name-dropping): Facets, QNXT, HealthRules, or equivalent
Demonstrated ownership of: Configuration decisions, Eligibility error queues, Vendor integrations (ID cards, print/mail, etc.)
Strong orientation toward metrics and controls, not just throughput: Enrollment accuracy rate, Retroactivity volume, 834 reject rates / auto-adjudication rates, Billing variance / reconciliation accuracy
Experience building: Daily/weekly operational dashboards, Audit controls
Proven track record in: New line of business launches, System migrations or platform conversions, Large-scale membership growth or M&A integration
Knows how to stand up: Parallel testing, File validation frameworks, Go-live stabilization models
Has led teams that manage high-volume, high-accuracy transactional work
Instills discipline around: SLAs, Quality assurance, First-time-right processing
Can articulate how enrollment evolves from: Transactional processing to proactive eligibility management
Experience reducing: Call volume driven by eligibility issues, Claims rework driven by enrollment defects
Brings a continuous improvement mindset (Lean, Six Sigma, or equivalent rigor)
Proven ability to partner with: IT (especially around 834s, EDI, platform configs), Claims (eligibility defect leakage), Customer service (call drivers tied to enrollment errors)
Can translate operational issues into financial and member impact language
Experience holding vendors accountable: ID card production SLAs, Print/mail timelines, Clearinghouse performance
Strong governance discipline (QBRs, SLAs, penalties, etc.)
Builds teams that: Understand why accuracy matters (not just processing speed), Are resilient during peak cycles (AEP, Medicaid redeterminations)
Experience leading through: High-pressure cycles, Regulatory change, Ambiguity during implementations
Bachelor's degree required.
Previous customer service and management experience required.

Benefits

Medical, Dental, Vision plans
Adoption, Fertility and Surrogacy Reimbursement up to $10,000
Paid Time Off and Sick Leave
Paid Parental & Family Caregiver Leave
Emergency Backup Care
Long-Term, Short-Term Disability, and Critical Illness plans
Life Insurance
401k/403B with Employer Match
Tuition Assistance – $5,250/year and discounted educational opportunities through Guild Education
Student Debt Pay Down – $10,000
Reimbursement for certifications and free access to complete CEUs and professional development
Pet Insurance
Legal Resources Plan
Colleagues have the opportunity to earn an annual discretionary bonus if established system and employee eligibility criteria is met.