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Manager Enrollment and Billing - 043272
To be fully engaged in providing Quality/No Harm, Customer Experience, and Stewardship by driving the daily tactical function of assigned units in line with organizational strategy.
The incumbent will provide leadership and oversight of team operations, developing and implementing a strategy for processing eligibility, premium billing and broker transactions, as well as ensuring the documented processes and procedures support a culture of continual improvement while meeting all regulatory and contract requirements. This individual’s primary role is to implement and execute policies to ensure that departmental priorities, schedules and deliverables are attained. They have responsibility for achieving budget targets, planning, scheduling and procedural changes. They focus on monitoring operational efficiency, process documentation, and managing, quality outcomes to ensure deadlines are met. They provide regular input to Leadership regarding past, current and projected performance of personnel and teams. Conducts risk assessments and devises actionable steps to mitigate risks. The individual in this position works collaboratively across the span of the organization in pursuit of top line performance while ensuring that processes are executed timely and accurately. Drives business plan deliverables with functional/project managers. Sets realistic and measurable unit goals in line with corporate entity goals. Develops and fosters a healthy work culture that promotes performance and team.
Assembles and prepares unit staff to deliver on tactical function: Builds capable teams with the knowledge, skills and experience to achieve results. Communicates and clarifies expectations, timeframes and deliverables. Provide leadership that fosters development and growth of staff.
Works with Supervisors to develop team bench strength that meets projected future needs.
Actively works to recruit, hire, and retain high performers; constantly looking for talent to add to the team. Values the difference that each employee makes and connects their role to organizational and unit success. Provides direction and guidance that promotes collaborative efforts between departments.
Provides timely guidance and feedback to help others strengthen specific knowledge and develop skill areas to accomplish tasks or solve problems.
Creates and communicates a compelling vision that motivates others; conveys the purpose and importance of serving the customer. Links department, team, and individual initiatives to the entity goals regarding customer experience.
Processes eligibility, premium billing, and consuming yearly revenue for the Health Plan in excess of $800 million dollars. In addition, the Manager is also responsible for Broker Commission calculations and payments in excess of $9 million dollars
Ensures oversite and appropriate financial and process controls related to timely processing and reconciliation of member, group, and broker accounts
Operates the department in compliance with CMS, Insurance Department, Federal, and State regulations and guidelines.
Ensures the integrity of enrollment and payment data by implementing processes that compare Federal and/or State sources of enrollment information (834, roster, etc.) to the core enrollment and eligibility system to ensure that all enrollment and disenrollment activity is captured accurately and that HFHP is appropriately paid by governing entities, groups and subscribers.
Accountable for the administrative management duties required of a management role. These activities include but are not limited to; budgeting/financial management, inventory control, hiring/staff planning and role clarification, performance planning and performance assessment.
Analyzes and makes recommendations regarding appropriate management of administrative expense including processing accuracy, quality improvement and system capability.
Strategically pivots to meet the needs and expectations of the membership and community
Consistently displays and holds associates accountable to the highest level of customer experience
Establishes and executes a detailed renewal plan for all lines of business, focusing on member retention and member satisfaction.
Understands member billing and enrollment processes in order to optimize and streamline current processes effectively.
Translates business strategy into an actionable tactical plan. Responsible for creating the business plan to carry out unit goals and strategy. Influences/provides input to Senior Leadership regarding the feasibility of unit vision and goals. Conducts risk assessments and devises actionable steps to mitigate risks. Works with appropriate partners to determine the best strategy to achieve vision and goals.
Oversees Service Level Agreements (SLAs) and communicates to operational areas the outcomes. Leads the effort to conduct rigorous monthly operating reviews detailed and focuses on negative variances and their corrective action plans.
Assists director in the development of the unit's annual budget, including operating and capital budget planning
Compliance and Regulatory responsibilities may include: Managing reconciliation and reporting deliverable
Addressing internal and external audits
Responsible for account reconciliation and any related reporting deliverables
Participate in and lead state operations and technical calls
Support audits by providing data/universes for audit requests
Interact with regulatory authorities as needed to support enrollment and billing processes
MINIMUM QUALIFICATIONS REQUIRED:
BS in Accounting, Business, Health Care or related field
Direct supervisory or management experience in an operational department within the healthcare industry (which can include commercial insurance plan, hospital, nursing home, third party administrators, or other related area).
Leadership experience in a high-volume production billing, enrollment, claims, call center environment or related environment.
Experience with User Acceptance Testing, Data Analysis/Reporting and defining Business Requirements.
Strong leadership skills to include organizational skills, decision-making, personnel direction and project management.
Knowledge of Medicare, Commercial and Individual products required.
Strong communication and presentation skills.
Must be a subject matter expert in one or more of the following Health Plan areas: Claims, Enrollment, Financial Operations Member & Group Services, Quality, Third Party Liability or Fraud, Waste and Abuse (FWA).
Three years direct Health Plan experience preferred.
May be required to work overtime to include extended hours or weekends.
Ability to sit for long periods
Manual dexterity required for typing and filing
Visual acuity and hand-eye coordination to perform various tasks.
Ability to work in a fast-paced environment balancing multiple priorities.
Ability to respond to requests in a timely fashion
Ability to adapt to a variety of changing duties as required to support all departments
Ability to work and maintain composure in a highly stressful environment
Ability to efficiently and accurately prioritize multiple tasks or project simultaneously
Time: Full time
Updated: 7/31/2019 3:05:54 PM