Manager, Enrollment Operations – Health Plan Enrollment Experience Required

Job not on LinkedIn

🔥 2 minutes ago

🇺🇸 United States – Remote

💵 $83k - $132.8k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

⚙️ Operations

🦅 H1B Visa Sponsor

This company has sponsored H1B visas in the past.

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CareSource

WebsiteLinkedInAll Job Openings

1001 - 5000 employees

Founded 30+ years

🏥 Healthcare

🛡️ Insurance

⚕️ Healthcare Insurance

Healthcare • Insurance • Healthcare Insurance

CareSource is a health services company focused on providing affordable health insurance and healthcare solutions. It offers a wide range of plans including Medicaid, Marketplace, and Medicare Advantage, targeting low-income adults, families, children, pregnant women, elderly adults, and people with disabilities. Additionally, CareSource provides members with resources for COVID-19 support, dental, vision, and hearing benefits, as well as pharmacy services. The company emphasizes easy access to healthcare management through online platforms and a mobile app.

📋 Description

• Provide leadership and direction to the Enrollment team • Ensure department and CareSource goals and standards are met • Manage staff to ensure timely, accurate, high-quality completion of service items • Oversee financial and member enrollment reconciliation for assigned lines of business • Oversee vendor eligibility extract processes • Ensure compliance with regulatory requirements • Manage enrollment technology and process analysts and activities involving 834 and DTRR file processes and departmental policies and procedures • Manage enrollment audit engagements and develop corrective action plans as needed • Gather, analyze, and report department performance data and recommend process improvements • Participate in development of new products and technologies • Manage daily operations and projects through resource allocation • Develop and maintain knowledge of the company’s business and regulatory environments • Incorporate change and risk management controls • Hire, train, coach, and develop direct reports, including performance appraisals and disciplinary actions • Mentor team leads and team members • Perform other related duties as requested

🎯 Requirements

• Bachelor's degree required, or 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 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 preferred • Strong knowledge of regulatory reporting and compliance requirements preferred • Proficient in online services and 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 prioritize and execute tasks in a high-pressure environment • Ability to defuse tension and manage conflict • Advanced written and verbal communication skills • Excellent mentoring and coaching skills • Excellent decision-making and problem-solving skills • Strong critical thinking, listening, and analytical thinking skills • Licensure and certification: None required • General office environment; may sit or stand for extended periods

🏖️ Benefits

• Bonus tied to company and individual performance may be available • Substantial and comprehensive total rewards package • Employee total well-being support