Manager, Enrollment-Remote

Molina Healthcare•Long Beach, CA

2d•Remote

About The Position

Job Summary Leads and manages team responsible for member enrollment activities. Collaborates with internal and external partners - leveraging expertise and knowledge of enrollment function to resolve member enrollment/eligibility issues. Essential Job Duties • Demonstrates oversight for the enrollment team including but not limited to hiring, training, coaching, production and performance. • Oversees day-to-day functions of enrollment production, scheduling, monitoring, reporting and corrective action/escalations. • Represents as the primary point of contact for the internal partners, i.e. Medicare administration, compliance and health plan operations - coordinating and facilitating meetings, and providing appropriate documentation and follow-up on action items. • Informs leadership of potential risks, and provides input on possible mitigation steps and implements changes. • Ensures staff follow enrollment processes and established guidelines, and provides appropriate follow-up on peer review findings. • Identifies and communicates opportunities for enrollment process improvement to leadership. • Demonstrates knowledge of state, federal, and business regulatory requirements, strong knowledge of the internal system, and knowledge of other state-specific applications related to managed care enrollment. • Ensures timely reconciliation of eligibility files and meets regulatory and health plan requirements. • Documents and maintains department enrollment-related workflows, job aids and policies, and provides appropriate staff training accordingly. • Records and manages enrollment issues and collaborates with other business partners to resolve and communicate solutions as needed. • Communicates and follows-up on files delayed by state, or issues with enrollment files that require state involvement. • Partners with vendor management team and external vendors to ensure service level agreements (SLAs) and regulatory requirements are met. • Considers downstream and upstream impacts to other departments related to enrollment changes, and coordinates with center of excellence team as needed. • Coaches and mentors staff, and ensures goal setting and enrollment score card development processes are facilitated. • Monitors and enforces compliance with enterprise-wide processes and develops departmental workflows accordingly. • Oversees maintenance of processes and procedures for enrollment function, including monthly reporting for leadership. • Completes analysis of data to ensure accuracy and oversight of data entered through both automated processes and manual inputs. • Ensures quality control of data entered into internal system/sent to external vendors. • Oversees and participates in state, federal, and internal enrollment-related audits as needed. • Participates in process improvement initiatives to improve enrollment operations. • Demonstrates understanding of compliance and regulatory guidelines for each state/health plan. • Collaborates with both corporate and health plan partners as a subject matter expert for enrollment process initiatives/implementations. • Participates in enrollment-related meetings/calls with state agencies. • Ensures succession plan is in place, and coaches/mentors high potential staff. • Ensures staff is compliant with regulatory and company guidelines, including Health Insurance Portability and Accountability (HIPAA).

Requirements

At least 7 years of experience in health care, including at least 4 years of enrollment experience in a managed care setting, or equivalent combination of relevant education and experience.
At least 1 year of management/leadership experience.
Knowledge of managed care rules, regulations and benefits.
Strong customer service experience.
Strong organizational and time-management skills, and ability to multi-task.
Problem-solving skills, and ability to collaborate cross-functionally across a highly matrixed organization.
Ability to maintain confidentiality and comply with the Health Insurance Portability and Accountability Act (HIPAA).
Team oriented and strong sense of customer focus.
Ability to establish and maintain positive and effective work relationships with coworkers, members, providers and customers.
Strong verbal and written communication skills.
Microsoft Office suite and applicable software programs proficiency.

Responsibilities

Leads and manages team responsible for member enrollment activities.
Collaborates with internal and external partners - leveraging expertise and knowledge of enrollment function to resolve member enrollment/eligibility issues.
Demonstrates oversight for the enrollment team including but not limited to hiring, training, coaching, production and performance.
Oversees day-to-day functions of enrollment production, scheduling, monitoring, reporting and corrective action/escalations.
Represents as the primary point of contact for the internal partners, i.e. Medicare administration, compliance and health plan operations - coordinating and facilitating meetings, and providing appropriate documentation and follow-up on action items.
Informs leadership of potential risks, and provides input on possible mitigation steps and implements changes.
Ensures staff follow enrollment processes and established guidelines, and provides appropriate follow-up on peer review findings.
Identifies and communicates opportunities for enrollment process improvement to leadership.
Demonstrates knowledge of state, federal, and business regulatory requirements, strong knowledge of the internal system, and knowledge of other state-specific applications related to managed care enrollment.
Ensures timely reconciliation of eligibility files and meets regulatory and health plan requirements.
Documents and maintains department enrollment-related workflows, job aids and policies, and provides appropriate staff training accordingly.
Records and manages enrollment issues and collaborates with other business partners to resolve and communicate solutions as needed.
Communicates and follows-up on files delayed by state, or issues with enrollment files that require state involvement.
Partners with vendor management team and external vendors to ensure service level agreements (SLAs) and regulatory requirements are met.
Considers downstream and upstream impacts to other departments related to enrollment changes, and coordinates with center of excellence team as needed.
Coaches and mentors staff, and ensures goal setting and enrollment score card development processes are facilitated.
Monitors and enforces compliance with enterprise-wide processes and develops departmental workflows accordingly.
Oversees maintenance of processes and procedures for enrollment function, including monthly reporting for leadership.
Completes analysis of data to ensure accuracy and oversight of data entered through both automated processes and manual inputs.
Ensures quality control of data entered into internal system/sent to external vendors.
Oversees and participates in state, federal, and internal enrollment-related audits as needed.
Participates in process improvement initiatives to improve enrollment operations.
Demonstrates understanding of compliance and regulatory guidelines for each state/health plan.
Collaborates with both corporate and health plan partners as a subject matter expert for enrollment process initiatives/implementations.
Participates in enrollment-related meetings/calls with state agencies.
Ensures succession plan is in place, and coaches/mentors high potential staff.
Ensures staff is compliant with regulatory and company guidelines, including Health Insurance Portability and Accountability (HIPAA).