Manager, Enrollment Operations (MCO/DSNP Enrollment experience required)

Job Summary:

The Manager, Enrollment Operations provides leadership and direction to the Enrollment team to ensure the goals and standards of the department, and CareSource, are met.

• Essential Functions:
• •Understand enrollment end to end processes and able to comprehend impact of any enrollment issues to various departments in the organization

Responsible for quality of outputs and operational efficiency of the team

Responsible for managing staff to ensure timely, accurate and high quality completion of service items for internal customers

Oversee the financial and member enrollment reconciliation for assigned lines of business

Oversee vendor eligibility extract processes to ensure accurate and timely processing of eligibility data

Responsible for complying with and meeting all regulatory requirements assigned to their team

Manage enrollment technology and process analysts and associated activities involving 834 or Daily Translation Reply Report (DTRR) file processes and departmental P&P’s

Manage all enrollment audit engagements to ensure accurate and timely response. As necessary, develop and implement corrective action plans to address audit results

Gather, analyze, and report data related to the performance of the department and make recommendations for process improvement(s)

Actively participate in ongoing development of new products and technologies

Manage daily operations and projects through effective allocation of resources

Develop and maintain an in-depth knowledge of the company’s business and regulatory environments

Incorporate effective change and risk management controls

Responsible for hiring, training, coaching and developing direct reports including completing performance appraisals and disciplinary actions

• •Mentor team leads and team members to produce consistent, high quality deliverables
• •Performs any other job related duties as requested.

• Education and Experience:
• •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

• Competencies, Knowledge and Skills:
• •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

Effective people management/leadership skills

Strong knowledge of database management desired

Knowledge of working with IT teams and providing requirements

Ability to effectively prioritize and execute tasks in a high-pressure environment

Ability to defuse tension and manage conflict among and between teams and members

Advanced communication skills (both written and verbal) and ability to work with multi-disciplinary departments across the organization

Excellent mentoring and coaching skills

Persuasive, encouraging, and motivating

Excellent decision making/problem solving skills

Strong critical thinking and listening skills

Analytical thinking

Leads by example

Actively gathers appropriate level of participation and input to decision-making and fosters it within teams

Focuses and aligns actions and decisions on ways to enhance service and Member experience

• Licensure and Certification:
• •None required

• Working Conditions:
• •General office environment; may be required to sit or stand for extended periods of time
• •Travel is not typically required

Compensation Range:

$83,000.00 - $132,800.00 CareSource takes into consideration a combination of a candidate’s education, training, and experience as well as the position’s scope and complexity, the discretion and latitude required for the role, and other external and internal data when establishing a salary level. In addition to base compensation, you may qualify for a bonus tied to company and individual performance. We are highly invested in every employee’s total well-being and offer a substantial and comprehensive total rewards package.

Compensation Type (hourly/salary):

Salary

Organization Level Competencies

Fostering a Collaborative Workplace Culture

Cultivate Partnerships

Develop Self and Others

Drive Execution

Influence Others

Pursue Personal Excellence

Understand the Business

This job description is not all inclusive. CareSource reserves the right to amend this job description at any time. CareSource is an Equal Opportunity Employer. We are dedicated to fostering an environment of belonging that welcomes and supports individuals of all backgrounds.

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Brand=CareSource