At a glanceSummarised by Seekless from the posting.
Must have20
Bachelor's degree required
Three (3) years of leadership/management experience required
Three (3) years of enrollment/reconciliation/call center experience required
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
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
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
None required
Nice to have4
Expert proficiency in Facets subscriber and member setup, benefits eligibility [including COB], and proficiency in the Customer Service application is preferred
Knowledge of enrollment reconciliation is preferred
Strong Knowledge of regulatory reporting and compliance requirements is preferred
Strong knowledge of database management desired
Eligibility1
Equivalent years of relevant work experience may be accepted in lieu of required education
Skills
Facets
HIPAA 834
EDI 270/271
DTRR
MMR
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
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Responsible for quality of outputs and operational efficiency of the team
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Responsible for managing staff to ensure timely, accurate and high quality completion of service items for internal customers
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Oversee the financial and member enrollment reconciliation for assigned lines of business
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Oversee vendor eligibility extract processes to ensure accurate and timely processing of eligibility data
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Responsible for complying with and meeting all regulatory requirements assigned to their team
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Manage enrollment technology and process analysts and associated activities involving 834 or Daily Translation Reply Report (DTRR) file processes and departmental P&P’s
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Manage all enrollment audit engagements to ensure accurate and timely response. As necessary, develop and implement corrective action plans to address audit results
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Gather, analyze, and report data related to the performance of the department and make recommendations for process improvement(s)
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Actively participate in ongoing development of new products and technologies
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Manage daily operations and projects through effective allocation of resources
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Develop and maintain an in-depth knowledge of the company’s business and regulatory environments
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Incorporate effective change and risk management controls
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Responsible for hiring, training, coaching and developing direct reports including completing performance appraisals and disciplinary actions
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Mentor team leads and team members to produce consistent, high quality deliverables
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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
Compensation Range:
$83,000.00 - $132,800.00
CareSource takes into consideration a combination of a candidate’s education, training, and experience as well as the position’s scope and complexity, the discretion and latitude required for the role, and other external and internal data when establishing a salary level. In addition to base compensation, you may qualify for a bonus tied to company and individual performance. We are highly invested in every employee’s total well-being and offer a substantial and comprehensive total rewards package.
Compensation Type (hourly/salary):
Salary
Organization Level Competencies
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Fostering a Collaborative Workplace Culture
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Cultivate Partnerships
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Develop Self and Others
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Drive Execution
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Influence Others
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Pursue Personal Excellence
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Understand the Business
This job description is not all inclusive. CareSource reserves the right to amend this job description at any time. CareSource is an Equal Opportunity Employer. We are dedicated to fostering an environment of belonging that welcomes and supports individuals of all backgrounds.