Manager, Enrollment Operations (Health Plan Enrollment experience required)

CareSource • Ohio WFH, OH

7d • $83,000 - $132,800 • Onsite

About The Position

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. This role oversees the financial and member enrollment reconciliation for assigned lines of business, vendor eligibility extract processes, and manages enrollment technology and process analysts. The manager is responsible for complying with regulatory requirements, managing audit engagements, and driving process improvements. They will also participate in new product development, manage daily operations and projects, and ensure effective change and risk management controls.

Requirements

• 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
• Strong understanding of health plan enrollment processes
• 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
• Ability to effectively prioritize and execute tasks in a high-pressure environment
• Ability to defuse tension and manage conflict among and between teams and members
• Advanced communication skills (both written and verbal) and ability to work with multi-disciplinary departments across the organization
• Excellent mentoring and coaching skills
• Persuasive, encouraging, and motivating
• Excellent decision making/problem solving skills
• Strong critical thinking and listening skills
• Analytical thinking
• Leads by example
• Actively gathers appropriate level of participation and input to decision-making and fosters it within teams
• Focuses and aligns actions and decisions on ways to enhance service and Member experience

Nice To Haves

• 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
• Strong knowledge of database management desired
• Knowledge of working with IT teams and providing requirements

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.

Benefits

• Substantial and comprehensive total rewards package
• Bonus tied to company and individual performance

What This Job Offers

• Job Type: Full-time
• Career Level: Manager