Enrollment Manager: Meritain Health

ESSENTIAL DUTIES:

• Provide direction, guidance and education to staff.

• Develop and implement team goals and objectives.

• Facilitate communication between staff, Supervisor and Management.

• Work with staff to facilitate problem resolution and analysis.

• Complete the following benefit documentation: timesheets, employee performance appraisals, salary increases, and personnel assessments.

• Implement and modify policies and procedures including adherence to Medicare guidance as outlined in Chapter 2 of the Medicare Managed Care Manual (MMCM).

• Audit departmental compliance of Chapter 2 of the MMCM on a quarterly basis.

• Maintain appropriate staffing levels; conduct interviews when necessary.

• Ensure that all Medicare regulations and time frames are met including uploading and downloading enrollment and disenrollment information to CMS.

• Ensure adherence to the CMS RDS (Retiree Drug Subsidy) guidelines and timely communication to employer groups. Submit information in accordance with the RDS guidelines and work with the Pharmacy Benefit Manager to rectify claims issues to maximize reimbursement.

• Ensure timely reconciliations of all Medicare and commercial reports including, but not limited to, CMS enrollment and disenrollment files, RDS files, MEMOUT reports and employer group eligibility files.

• Responsible for the development and motivation of staff. Handle performance problems, disciplinary action, and other matters relating to personnel administration.

• Oversee daily enrollment tasks to ensure tasks are completed timely (functions include: all ongoing enrollment updates (including Medicare), CMS transactions, enrollment-related HIPAA transactions, additions, terminations, student verifications, and any associated letters).

• Resolve all client issues regarding enrollment services.

• Ensure timely and accurate membership service delivery through measurement of individual staff productivity and quality performance as benchmarked through corporate objectives.

• All other duties as deemed essential to job function.

REQUIRED KNOWLEDGE, SKILLS AND ABILITIES:

• Strong leadership, communication, organization, time management and problem solving skills
• Ability to handle multiple projects/priorities and meet required deadlines
• Flexible with ability to adjust well to changing priorities
• Strong knowledge of Word and Excel
• Ability to respond to inquiries/complaints and communicate effectively with others
• Ability to read and understand various forms, documentation, files and information in the department
• Strong customer service skills
• Ability to direct, coach and motivate subordinates
• Knowledge of operational procedures
• Ability to make decisions and exercise authority
• Strong verbal and written skills

QUALIFICATION STANDARDS

• Managerial skill demonstrated by previous supervision of employees (3+ years)
• Strong analytical skills
• Healthcare industry experience
• Strong working knowledge of Word and Excel
• Exceptional communication skills

The statements above describe the general requirements of the job but are not intended as an all-inclusive listing of duties that may be required of the individual in this position.