Manager, Enrollment

Versant Health•Troy, NY

11d

About The Position

Responsible for the management oversight, service delivery and reconciliation of all activities encompassed within the Enrollment department, including electronic, customer web portal enrollment and manual enrollment processing. The Manager of Enrollment and Billing will also directly support the implementation of new clients relative to enrollment and reporting requirement definition. Responsible for achieving business strategy objectives, standardized processes and oversight of quality, operational metrics, and performance guarantees related to service level goals. Identify and implement best practices to create support for our customers in a manner that is reflective of the Versant Health brand strategy. Oversee day-to-day operations for CV and CVX system enrollment activities

Requirements

Preferred Bachelor's degree in related field or equivalent combination of experience and education
5 years of experience in the managed care or health insurance industry with a working knowledge of Operational Departments such as Eligibility, Premium Billing, Collections, Customer Services, or Claims. .
Three (3) plus years managerial experience in a health insurer setting, including demonstrated experience in managing teams, setting goals/expectations, managing to timeline driven outcomes, and implementation of sustainable strategic solutions
Three (3) plus years of experience in the management of membership/EDI enrollment transactions ,and billing data processing
Minimum 2 years experience working with EDI enrollment files in a hands on capacity.
Thorough knowledge of health care insurance as might be shown by three to five years in an insurance company
Direct client interface experience
Sound administrative skills. Developed management skills – principles and people
Proven ability to identify and resolve potential challenges through analytical and logical means and effectively communicate recommendations for resolution
Ability to read and interpret detailed reports and evaluate and document business requirements
Strong knowledge of membership, and EDI enrollment workflows and processes
Proficiency in MicroSoft Office with experience in Excel sorting, queries, formulas, and charts required.
Excellent PC, communication, organizational and delegation skills
All Associates must comply with the Health Insurance Portability Accountability Act of 1996 (HIPAA) as it pertains to disclosures of protected health information (PHI) as described in the Notice of Privacy Practices and HIPAA Privacy Policies and Procedures. As a component of job roles and responsibilities, Associates may have access to covered information, cardholder data or other confidential customer information which must be protected at all times. As a result, Associates must explicitly adhere to all data security guidelines established within the Company’s Privacy & Security Training Program.

Responsibilities

Provide leadership, oversight and guidance in the completion of enrollment efforts for our internal CV/CVX Enrollment operations completed manually, via web portal or via EDI.
Establish goals for the Enrollment team to advance performance, monitor, lead and support the team to achieve improved performance.
Lead staff to successful completion of customer PG’s, monthly Operational metrics results and support of internal and external customer expectations.
Collaborate with the IT area to complete thorough testing of new and modified processes, software, and other system-oriented transaction sets.
Manage the Enrollment team to include selection, training and development, coaching, counseling and performance management.
Implement processes to ensure timely receipt, conversion, storage, transmission and customer receipt of agreed upon membership data, information and other materials.
Learn key department tasks and how to complete them to enable Manager to effectively lead team and interact with customers and IT team.
Work closely with the Enrollment and Billing team members related to invoice creation and processes to initiate the handling and resolution of any challenge or concerns that arise.
Support research activities needed for payment discrepancies as they relate to enrollment management.
Maintain in-depth knowledge of system enrollment and billing, Billing portal, RT system and HSP workflow items to lead team activities.
Establish standard expectations across the program, creating processes necessary for each unique system operation needs: Identifying, evaluating and prioritizing initiatives and resources; implementing through influence rather than direct line authority.
Assist in designing business and technical requirements to support new business functions, improve internal processes, and satisfy external customer requests, and change or enhance the functions of current programs for the same reasons
Monitor and lead staff efforts in the completion of team activities to meet and exceed defined metric objectives.
Prepare periodic status reports, personnel reviews and other management reports as requested
Manage all established SOC controls in accordance with defined expectations, monitoring weekly to ensure proper completion of tasks and retention of evidence of controls is completed. Monthly review and confirmation of controls completion and adherence required.
Develop and maintain effective business and personal relationships with all clients and internal departments
Conforms with and abides by all federal, state, and local regulations, company policies and procedures, and instructions. This includes guarantees, regulations, and commitments to Clients.
Ability to work independently while meeting task objectives and timeframes required
Independent work while supporting the needs of a remote team is necessary
Adheres to privacy, confidential, and proprietary company policies and procedures (i.e. HIPAA).
Participates in any training and educational activities necessary to fulfill at least the minimum requirements as specified within your departmental goals. This is in addition to, the completion of any activities necessary for the maintenance of professional affiliations or organizational requirements.
As required by changing business needs, completes additional responsibilities as assigned with occasional travel expected.
Develops, operationalizes and maintains department policies and procedure documents
Travel to vendor and Versant office may be necessary for 15% of work time