Manager, Enrollment-Remote

Overview

JOB DESCRIPTION Job Summary

Leads and manages team responsible for member enrollment activities. Collaborates with internal and external partners - leveraging expertise and knowledge of enrollment function to resolve member enrollment/eligibility issues.

• Demonstrates oversight for the enrollment team including but not limited to hiring, training, coaching, production and performance.
• Oversees day-to-day functions of enrollment production, scheduling, monitoring, reporting and corrective action/escalations.
• Represents as the primary point of contact for the internal partners, i.e. Medicare administration, compliance and health plan operations - coordinating and facilitating meetings, and providing appropriate documentation and follow-up on action items.
• Informs leadership of potential risks, and provides input on possible mitigation steps and implements changes.
• Ensures staff follow enrollment processes and established guidelines, and provides appropriate follow-up on peer review findings.
• Identifies and communicates opportunities for enrollment process improvement to leadership.
• Demonstrates knowledge of state, federal, and business regulatory requirements, strong knowledge of the internal system, and knowledge of other state-specific applications related to managed care enrollment.
• Ensures timely reconciliation of eligibility files and meets regulatory and health plan requirements.
• Documents and maintains department enrollment-related workflows, job aids and policies, and provides appropriate staff training accordingly.
• Records and manages enrollment issues and collaborates with other business partners to resolve and communicate solutions as needed.
• Communicates and follows-up on files delayed by state, or issues with enrollment files that require state involvement.
• Partners with vendor management team and external vendors to ensure service level agreements (SLAs) and regulatory requirements are met.
• Considers downstream and upstream impacts to other departments related to enrollment changes, and coordinates with center of excellence team as needed.
• Coaches and mentors staff, and ensures goal setting and enrollment score card development processes are facilitated.
• Monitors and enforces compliance with enterprise-wide processes and develops departmental workflows accordingly.
• Oversees maintenance of processes and procedures for enrollment function, including monthly reporting for leadership.
• Completes analysis of data to ensure accuracy and oversight of data entered through both automated processes and manual inputs.
• Ensures quality control of data entered into internal system/sent to external vendors.
• Oversees and participates in state, federal, and internal enrollment-related audits as needed.
• Participates in process improvement initiatives to improve enrollment operations.
• Demonstrates understanding of compliance and regulatory guidelines for each state/health plan.
• Collaborates with both corporate and health plan partners as a subject matter expert for enrollment process initiatives/implementations.
• Participates in enrollment-related meetings/calls with state agencies.
• Ensures succession plan is in place, and coaches/mentors high potential staff.
• Ensures staff is compliant with regulatory and company guidelines, including Health Insurance Portability and Accountability (HIPAA).

• At least 7 years of experience in health care, including at least 4 years of enrollment experience in a managed care setting, or equivalent combination of relevant education and experience.
• At least 1 year of management/leadership experience.
• Knowledge of managed care rules, regulations and benefits.
• Strong customer service experience.
• Strong organizational and time-management skills, and ability to multi-task.
• Problem-solving skills, and ability to collaborate cross-functionally across a highly matrixed organization.
• Ability to maintain confidentiality and comply with the Health Insurance Portability and Accountability Act (HIPAA).
• Team oriented and strong sense of customer focus.
• Ability to establish and maintain positive and effective work relationships with coworkers, members, providers and customers.
• Strong verbal and written communication skills.
• Microsoft Office suite and applicable software programs proficiency.

To all current Molina employees:
If you are interested in applying for this position, please apply through the Internal Job Board.

Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V