Provide effective leadership and supervision of Enrollment and Billing staff by managing performance, supporting professional development, ensuring appropriate staffing and coverage, and fostering a collaborative, accountable team environment that supports timely and accurate work outcomes.
Oversee enrollment and eligibility operations across all product lines, including state exchange plans, to ensure the timely, accurate, and complete administration of enrollment data across operational systems.
Evaluate and determine appropriate outcomes for customer exception requests.
Review and validate employer group accounts for accuracy, timeliness, and compliance.
Manage state exchange subscriber data, premium credits, and reporting responsibilities.
Prepare and submit required reimbursement reports to CMS and ensure alignment with regulatory guidelines.
Ensure compliance with HIPAA, ACA, CMS, and other applicable federal and state regulations.
Analyze enrollment, billing, and related operational data to assess performance and inform management decisions.
Demonstrate adaptability to evolving and emerging systems, tools, and workflows, and support the thoughtful adoption of new technologies that improve operational outcomes.
Identify operational trends and underlying issues, including manual adjustments, and recommend or implement corrective actions to prevent recurrence.
Partner with internal stakeholders, including IT and operational staff, to prioritize, implement, and validate process or system improvements.
Maintain departmental policies and procedures to support consistent, accurate, and compliant operations.
Build and maintain effective working relationships with internal partners such as IT, Finance, Claims, Customer Service, Sales, and Compliance.
Demonstrate a commitment to the organization’s vision, mission, values, code of ethics, and compliance/security standards.
Other duties as assigned.
Requirements
Bachelor’s degree in accounting, finance, business administration, or equivalent experience.
Proven management or supervisory experience in a billing, enrollment, healthcare, or insurance environment.
Strong proficiency in Microsoft Office applications, especially Excel, Word, and Outlook.
Excellent analytical, organizational, and problem-solving skills with the ability to manage multiple priorities.
Strong verbal and written communication skills with the ability to collaborate effectively across diverse teams and stakeholders.
Experience with state or government health exchanges (Idaho preferred).
Prior experience in healthcare, insurance, or financial services strongly preferred.
Ability to maintain confidentiality and work with sensitive information.