Direct and manage Molina Medicare Membership Accounting, conducting assessments of current operations, developing and implementing short- and long-term improvements, maintaining regulatory compliance, and working with appropriate functional areas to implement tactical and strategic initiatives.
Duties and Responsibilities
Manage budget, staffing assessment and fulfillment, compliance with CMS metrics and quality standards for Medicare Enrollment/Disenrollment processes.
Oversee operational workflows by managing all enrollment and disenrollment activities. This includes the receipt of all enrollment and disenrollment requests, data transmission files to CMS and the processing of Transaction Reply Report (TRR) and Batch Completion Status Summary (BCSS).
Improve processes by evaluating existing membership and payment reconciliation workflows. Coordinate cross-functional processes and implement improvements to software applications used in the enrollment/disenrollment process.
Retrieve, analyze and manipulate management data to identify and evaluate operational improvements to achieve goals. Provide Senior Leadership with recommendations based upon detailed analysis.
Identify improvement opportunities and lead improvement projects, including the implementation of staff training and P&P revisions. Ensure staff members operationally execute procedures documented within P&Ps. Correct discrepancies as needed.
Evaluate Medicare Health Plan expansions or enhancements of systems by analyzing the functionality of current systems and processes, providing detailed recommendations for process improvement.
Interface and educate sales/broker teams ensuring compliance and regulatory standards are achieved. Develop process improvement plans to exceed CMS standards for processing applications and create a culture of compliance with all related functional areas.
Establish and implement an automated process for tracking and reporting enrollment and eligibility discrepancies in collaboration with other department managers.
Balance compliance with numerous complex regulations and the realty of day to operations – achieving a compliant organization well grounded in operational excellence.
Provide guidance and information for staff members and other functional areas by interpreting Medicare guidelines and regulations.
Interface with regulatory agencies as required (primarily CMS).
Maintain a culture of excellence among staff members through coaching, counseling, planning and monitoring job results. This includes providing appropriate feedback that my result in disciplinary action.
Other duties as assigned
Develop strong relationships with key matrix partners, including sales, compliance, provider relations/contracting, state SMDs, and health plan management.
Serve as primary resource to communicate with DMOs and MHI, Medicare, Health Plan leadership regarding centralized operations. Develop and conduct training to ensure coordinated and efficient cross-functional operations.
Knowledge, Skills and Abilities
Excellent verbal and written communication skills
Ability to abide by Molina’s policies
Maintain regular attendance based on agreed-upon schedule
Maintain confidentiality and comply with Health Insurance Portability and Accountability Act (HIPAA)
Ability to establish and maintain positive and effective work relationships with coworkers, clients, members, providers and customers
Bachelor’s degree, preferable in healthcare management, or management-related.
Master’s in applicable field preferred
5+ years experience working in the Medicare managed healthcare field
3+ years Medicare enrollment/reconciliation including
Medicare operational/compliance experience
To all current Molina employees if you are interested in applying for this position please fill out an Employee Transfer Request Form (ETR) and attach it to your profile when applying online. Be sure to let us know you are a current employee by selecting “Molina Employee (current) in the source section of the online application.
Molina Healthcare offers competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V
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