Provide leadership and direction to the Enrollment team to ensure goals and standards of the department are met
Understand enrollment end to end processes and comprehend impact of any enrollment issues
Responsible for quality of outputs and operational efficiency of the team
Manage staff for timely, accurate and high quality completion of service items for internal customers
Oversee financial and member enrollment reconciliation for assigned lines of business
Oversee vendor eligibility extract processes for accurate and timely processing
Comply with and meet all regulatory requirements assigned to team
Manage enrollment technology and process analysts
Gather, analyze, and report data related to department performance for process improvements
Actively participate in ongoing development of new products and technologies
Develop and maintain knowledge of company's business and regulatory environments
Responsible for hiring, training, coaching and developing direct reports

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
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
Ability to effectively prioritize and execute tasks in a high-pressure environment
Advanced communication skills (both written and verbal)

Manager, Enrollment Operations

Key skills