Manager, Eligibility (50956)

GLOBALHEALTH HOLDINGS LLC•Oklahoma City, OK

1d•Remote

About The Position

The Manager, Eligibility position reports directly to the Director, Enrollment & Fulfillment and is primarily responsible for managing enrollment activities to facilitate and enhance the company’s operational and financial goals. Ensure the accurate, timely processing and data entry of Medicare enrollments, re-enrollments and disenrollment, subsequent maintenance of the enrollment data, compliance with regulatory requirements relating to enrollments and disenrollment, filing of applications, and other related documents. Address a variety of enrollment questions or concerns received via claims, call tracking, or email. Maintain all records in the enrollment systems.

Requirements

Bachelor’s Degree required.
3+ years Enrollment Processing related experience in Managed Care or Medicare setting
Processing CMS Transaction Files
Partners with any external vendor(s) to ensure service level agreements and regulatory requirements are met.
Proficient with Microsoft Office applications, including Word, Excel, Outlook and various database applications.
Detail oriented with problem-solving abilities.
Strong and effective verbal and written communication skills to multi- level audiences.
Exemplary interpersonal and customer service skills.
Demonstrates professionalism, poise, tact, and diplomacy in interactions with others.
Demonstrates good judgment, organization and prioritization skills and time management skills.
Proven leadership with staff, projects, and management.
Strategic thinking abilities and analytical skills
Ability to clearly present written information and findings, concisely communicate concepts and make executive-level presentations.
Strong understanding of eligibility and enrollment transactions in health care/managed care industry.
Ability to perform essential job functions with high degree of independence, flexibility, and creative problem-solving techniques.
Ability to function effectively under stress of conflicting demands on time and attention and, sometimes, under duress from difficult personalities.
Ability to multi-task, set priorities, and manage time effectively.
Intermediate accurate keyboarding skills.
Ability to function in a fast-paced, detail-oriented environment.
Efficiency in MS Office Suite (Word, Outlook, Excel)

Responsibilities

Responsible for preparation, timely processing of enrollment applications, management, and maintenance in accordance with CMS regulations.
Ensures compliance with all applicable policies, processes, and procedures.
Oversees the enrollment activities and reconciliation.
Strong knowledge of the Enrollment process along with State, Federal, and business regulatory requirements and other state specific applications concerning Managed Care Enrollment
Ensure quality control of data entered into membership database and sent to external vendors.
Oversees and participates in state, federal, and internal audits, as needed.
Responsible for the accurate and timely dissemination of eligibility data to the network, ancillary providers, and internal systems.
Partners with external vendors and is responsible for contracts for Medicare enrollment file transactions to CMS, ID Card printing and mailing and other vendors in support of eligibility operations.
Oversees external vendors on the development and implementation of tactical initiatives and processes that improve our retention efforts among current members.
Ensures staff is compliant with regulatory and company guidelines, including HIPAA compliance.
Partners with the Director, Enrollment and Fulfillment to establish departmental goals and objectives that support our mission and goals and ensure that individual performance goals support departmental goals.
Measures and monitors the status of goal achievement.
Partners with Director, Enrollment and Fulfillment to develop performance competencies and metrics that are meaningful and measurable and aligned with our business goals and objectives.
Ensures that agreed- upon performance competencies and metrics are meaningful and measurable; implemented timely; communicated and understood by the staff; and metrics are consistently met or exceeded.
Oversee and manage the auditing of enrollment and disenrollment information data and certify its completion and accuracy.
Develop, create, and implement policies and procedures, workflows and job aides as required to provide training for the Enrollment & Fulfillment department.
Reconcile monthly payments (Monthly Reply Listing Report) and discrepancies between data submitted to CMS and GlobalHealth records.
Responsible for ensuring timely reconciliation of eligibility files and adjustments to CMS that meet regulatory and health plan requirements, as required.
Coordinate and manage the generation and mailing of all necessary correspondence relating to enrollment, re-enrollment, and disenrollment in accordance with CMS time frames.
Responsible for communicating and following up on files delayed by CMS and/or State or issues with a file that require Health Plan involvement.
Reviews and analyzes all State agency reports/rosters/premium files and compares eligibility files to validate eligibility and intervene when discrepancies are identified.
Performs other duties as assigned