Essential Duties:
The Director of Enrollment must have a strong understanding of the enrollment and billing processes and reporting systems and a good understanding of insurance industry operations. Must have the ability to apply Information Technology; oral skills for individual or group communication and writing skills for clear and concise, technically-oriented documents.
The Director is responsible for the smooth and efficient management of the EmblemHealth group and Billing/Financial systems. In this capacity, the Director provides management oversight for the development of our corporate integrated systems. Provides vision, leadership and direction in the maintenance and improvement of all Membership functions to include Group Administration, and Billing, and a good understanding of all NYS Department of Insurance and Governmental regulatory mandates.
The Director will ensure that all EH insured and self-funded products and services are administered at industry-competitive service levels, meeting the needs of our members, customers and regulators.
Direct the overall activities of the Membership Department, including enrollment, billing statistical reporting, Direct Pay, COBRA, Membership reconciliations, Commercial group accounts, New York City, other governmental contracts and other Membership & Accounting related system issues. Act as department’s liaison internally and externally in all matters affecting Commercial enrollment, New York City, Medicare and other government programs administered by the HMO and PPO. Processing over 325,000 transactions for 670,000 lives
Direct, review, monitor and control the Membership and Billing operation with efficiency and effectiveness of the commercial, Medicare and other governmental programs. Develop quality and production standards to assure efficient workflow identifying inefficiencies, recommending and implementing solutions. Direct the design/revision and implementation of internal departmental systems and procedures. Direct and manage the implementation of NYS, Federal and CMS regulations. Ensure compliance with internal, Sarbanne-Oxley, SAS 70, CMS, NYS Market Conduct and Financial Examination and other audits.
Direct and monitor the issuance of ID cards to include coordinating with Sales/Account Management and Product Development to ensure provider and client needs are met. Responsible for accurate and timely issuance of ID cards. Issuing over 1 million ID cards annually.
Responsible for directing and ensuring a successful implementation of external vendor systems and appropriate interfaces with EmblemHealth’s legacy systems. Direct the development of data exchange software from a user perspective to ensure high performance standard
Serve as a principal representative of the Enrollment Department, maintaining and developing relationships with key internal and external personnel to resolve enrollment, cancellations, changes and other enrollment related issues including all government submissions.
Identify and resolve member concerns, including tracking enrollment related issues and coordinating with different operational areas in the resolution of issues affecting EmblemHealth’s members.
Direct the submission and monitoring of daily, weekly and monthly inventory report of operating area to determine departmental efficiency and maintain the integrity of our corporate enrollment file.
Participate in strategic planning with senior management.
Assist in the preparation of the corporate capital budget and the monitoring of monthly expenditures for the enrollment department
Knowledge Skills & Abilities:
Strong Analytical Skills
Strong Troubleshooting Skills
Effective Communication Skills
Driven/Determined to do well
Good Judgment
Strong Leadership Skills
Ability to Plan
Effective Team Building Skills
Problem Solving Skills
Ability to work under pressure
Multi-tasker
Qualifications:
Bachelor’s degree in Business Administration, Management and/or Accounting
A minimum of 7 years management experience in a high-volume operation
CMS, Medicare and project management work experience required
Knowledge of premium income allocation required
Internal posting expires on 7/6/12.
EmblemHealth - 11 months ago
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