Job Description :
The Director of Enrollment & Billing is responsible for leading enrollment and billing operations for commercial group, individual and business partner functions. This position is responsible for motivating and cultivating a team to provide excellent service allowing for a consumer centric approach balanced with a cost competitive structure to achieve opportunities for additional business. Directs the technology and operations strategy related to member data exchanges, enrollment and OPL processing. Assess systems, processes and people and make recommendations. Define business requirements for software programs used to load, maintain, or transmit eligibility information. Responsible for delegation oversight for subcontractors as well as communicating strategic direction and business requirements related to Medicare enrollment processing and Other Party Liability identification and post payment recoveries… Review, document, and communicate software requirements to various vendors to ensure that both internal and external systems perform as required. Work with multiple external entities to ensure that the vendor’s eligibility data is accurate and that the applicable membership software is performing as required. Provide oversight and direction of the outsourced IS production center for each product line.
1. Provide leadership and oversight of management for service operations. Participate in the formulation and execution of the division’s service operations strategy and vision.
2. Establish, monitor and work with team to continuously improve on all aspects of enrollment & billing operations. Direct the daily production activities of team members to deliver accurate, timely and efficient service to customers. Ensures accurate and timely updates to membership records.
3. Ensure all operational processes are in compliance with established quality standards, government and industry regulations, and client requirements.
(If required: CMS Reporting) Accountable for CMS required reporting and operating a CMS regulated business in compliance with Medicare C&D regulations.
4. Work closely with other management areas to ensure operational consistency within the organization and all lines of business. Provides direction, feedback and final approval on the setup of various systems to allow for accurate membership reporting and reconciliation.
5. Ensure high quality employees are hired for team and provide coaching, mentoring, and leadership to direct reports and team.
6. Provide significant input and direction to the development of future operational capabilities by evaluating, investigating and recommending newly defined systems, process and techniques.
7. Direct and ensure that all budget guidelines are met.
8. Responsible for all aspects of the systems and processes to operate Plan Partner’s business as well the membership data conversion, coordination with corporate systems, branding compliance for government required mailings, Service Level Agreements adherence and reporting, managing staffing in accordance with pricing model provided to Plan Partner and regulatory compliance.
9. Other duties as assigned or requested.
Education, Licenses/Certifications, and Experience (For Experience requirements please see appropriate role/level guide. If not applicable, list experience requirements below.)
- Bachelor’s Degree or 7+ years related experience
- 7 years of experience in large operations environment
- 7 years of experience with insurance products principles, industry practices, and processes
- Master’s Degree
- 5 years of experience of insurance product knowledge
- 5 years of experience in workforce development and resource management
- 3 years of experience marketing or selling services for operational capabilities
- 3 years of experience with project management
Knowledge, Skills and Abilities
- Experience to effectively manage, direct, and motivate staff.
- Demonstrated track record of operational effectiveness.
- Strategic thinking and planning.
- Must be willing to travel to meet with clients, attend conferences as well as assist Sales with site visits to potential clients.
- Financial and budget/expense management experience.
- Ability to handle multiple priorities and the ability to identify, analyze and solve problems independently.
- Strong organizational and analytical skills
- (If required: Ability to interpret and understand complex government regulations.)
- (If required: Comprehensive knowledge of Medicare regulations, law and coverage issues.)
IV. SCOPE OF RESPONSIBILITY (People Management Responsibility)
Does this role supervise/manage other employees?
Yes. Number of direct reports: 4-8
V. WORK ENVIRONMENT
Is Travel Required?
Referral Level Payout 3
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