Manager, Enrollment Operations (MCO/DSNP Enrollment experience required)

Job Summary:

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.

• Essential Functions: 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.

• Education and Experience: 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
• Competencies, Knowledge and Skills: Strong understanding of health plan enrollment processes
• 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
• 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
• Strong knowledge of database management desired
• Knowledge of working with IT teams and providing requirements
• 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
• Licensure and Certification: None required
• Working Conditions: General office environment; may be required to sit or stand for extended periods of time
• Travel is not typically required