Manager-Enrollment (Remote/Hybrid, North Carolina Based)

The Enrollment Manager is responsible for the oversight of Alliance’s Medicaid and State funded Eligibility and Enrollment Operations. This position manages the activities, processes and procedures required to ensure adherence with NC Medicaid and State requirements.

This is a full-time primarily remote opportunity. There is no expectation of being in the office routinely, however, the selected candidate must be available to report onsite for business meetings as needed at the Alliance Home office (Morrisville, North Carolina).  

 Responsibilities & Duties

Manage and Develop Staff

• Work with Human Resources and Claims leadership to attract, maintain, and retain a highly qualified and well-trained workforce
• Ensure staff are well trained in and comply with all organization and department policies, procedures, and business processes
• Organize workflows and ensure staff understand their roles and responsibilities
• Ensure the department has the needed tools and resources to achieve organizational goals and to support employees and ensure compliance with licensure, regulatory, and accreditation requirements
• Actively establish and promote a positive, diverse, and inclusive working environment that builds trust
• Ensure all staff are treated with respect and dignity
• Ensure standards are transparent and applied consistently, impartially, and ethically over time and across all staff members
• Work to resolve conflicts and disputes, ensuring that all participants are given a voice
• Set goals for performance and deadlines in line with organization goals and vision
• Effectively communicate feedback and provide ongoing coaching and mentoring to staff and support a learning environment to advance team skills and professional development
• Cultivate and encourage efforts to expand cross-team collaboration and partnership

Third Party Liability Oversight

• Manage collaborative efforts with IT, other departments and vendors
• Operate as the lead contact with efforts with TPL vendor
• Manage and evaluate enrollment processes, establish and validate workflows, identify and resolve operational gaps where identified
• Implement best practices and innovative solutions to streamline processes and enhance third party liability management
• Responsible for management and execution of TPL contract requirements and ensuring all practices adhere to legal and regulatory standards
• Monitor performance of team and vendor through regular reporting requirements
• Stay current on federal, state and local regulations affecting third party liability and enrollment processes 
• Serve as the subject matter expert and point of contact for State and Medicaid stakeholders
• Coordinate with Legal and Compliance in recoveries and cases of subrogation
• Responsible for report deliverables including accuracy of data and timeliness of submission
• Conduct research, analyze data, and make recommendations regarding coordination of benefits

Medicaid Eligibility and State Enrollment

• Review system reports to ensure compliance with Eligibility and Enrollment policies and procedures
• Responsible for review of report deliverables that are managed by IT
• Stay current on federal, state and local regulations affecting Medicaid enrollment and State eligibility
• Serve as the subject matter expert and point of contact for State and Medicaid stakeholders
• Manage Client Data Warehouse (CDW) process and collaboration with IT for successful submissions to ensure compliance with state rules and timeframes, review and monitor results and provide regular updates to leadership
• Oversee standards for recipient enrollment in State benefit plan

Minimum Requirements

Education & Experience

Bachelor’s degree in Business Administration or related field from an accredited college/university and at least five (5) years Enrollment and Claims Processing related experience in Managed Care or Medicare setting including three (3) years of experience in a government payor environment with experience in multiple lines of business (Medicare, Medicaid, Healthcare Exchange, etc).

Knowledge, Skills, & Abilities

• Adept at researching data systems for inaccuracies
• Knowledge of Medicaid and SSI/SSDI eligibility criteria, referral processes, and local program requirements for services to children, adolescents, families and adults
• Knowledge of community resources and financial resources available for health/medical services to the public
• Ability to use research to seek additional information
• Ability to resolve complex problems that require the evaluation of alternative methods and solutions
• Ability to set objectives, delegate, and prioritize workflow
• Proficient in written and oral communication sufficient to handle projects and problems
• Ability to make prompt decisions on complex matters and make evaluations concerning day to day operations
• Knowledge of basic medical coding and third party operating procedures and practices
• Proficient with Microsoft Office applications, including Word, Excel, Outlook and various database applications

Employment for this position is contingent upon a satisfactory background check and credit check, which will be performed after acceptance of an offer of employment and prior to the employee's start date. 

Salary Range 

$86,800-$110,670.00/Annually 

Exact compensation will be determined based on the candidate's education, experience, external market data and consideration of internal equity. 

 An excellent fringe benefit package accompanies the salary, which includes:   

• Medical, Dental, Vision, Life, Long Term Disability
• Generous retirement savings plan
• Flexible work schedules including hybrid/remote options
• Paid time off including vacation, sick leave, holiday, management leave
• Dress flexibility