Eligibility and Enrollment Manager (Remote Option)

Competitive Compensation & Benefits Package!  

Position eligible for – 

• Annual incentive bonus plan
• Medical, dental, and vision insurance with low deductible/low cost health plan
• Generous vacation and sick time accrual
• 12 paid holidays
• State Retirement (pension plan)
• 401(k) Plan with employer match
• Company paid life and disability insurance
• Wellness Programs
• Public Service Loan Forgiveness Qualifying Employer

See attachment for additional details. 

Office Location:  Remote Option; Available for the any of Partners' NC locations

Closing Date: Open Until Filled

Primary Purpose of Position: The primary purpose of this position is to provide direct oversight to the organization’s Medicaid and State-funded Tailored Plan and Medicaid Direct Eligibility and Enrollment operations. This position manages the organization’s activities and responsibilities necessary to execute eligibility and enrollment transactions and ensure processes are efficient and applicable to NC Medicaid requirements and internal policies and procedures. This role requires positive leadership skills, a collaborative approach to problem solving that includes staff involvement, process improvements and serves as a liaison between staff, members and providers. Work involves close collaboration with IT, health plan partner and other departments.  

Role and Responsibilities:  

Responsibilities may include but are not limited to: 

• Drive operational performance for each core process to meet contractual requirements and align with the company strategic objectives.
• Oversee day-to-day eligibility and enrollment efforts including hold daily and/or weekly huddles, assess risk and remediate enrollment file management risks, drive priorities and escalation resolutions and inquiries to ensure complete, accurate and timely responses.
• Lead organizational cross-functional reviews of end-to-end enrollment processes, establish and validate workflows, identify and resolve operational gaps as - needed basis.
• Develop, review and meet organization criteria related to enrollment operations, turnaround times, reconciliation, quality, regulatory and accuracy requirements.
• Collaborates with various IT and data teams to identify infrastructure related issues that have resulted in application issues.
• Aggressively manage personal workload related to open issues and service requests to ensure agreed upon SLA’s are met.
• Monitor operational performance metrics ensuring plan reporting requirements are met timely and within plan compliance and enrollment deadlines.
• Partner with enrollment peers to generate and validate performance goals, reporting deliverables and audits.
• Participate in the presentation of information to customers and internal business areas.
• Lead cross-functional performance improvement initiatives focused on quality and efficiency and downstream processes.
• Demonstrate a solid understanding of operational processes and controls and monitors the execution of operational changes required by regulations and guidelines associated with Medicaid enrollment.
• Provide guidance on delegated function oversight, including dashboard development as needed.
• Assist in enhancing metrics related to delegation oversight to ensure compliance with regulatory and plan requirements.
• Serve as the subject matter expert and point of contact for state Medicaid stakeholders.
• Ensure all records and files are securely maintained and confidential information is handled with utmost discretion in compliance with legal and compliance department policies.
• Create and document process flows, functional and technical requirements in user stories, process maps for user experience design, testing and implementation.
• Accountability for the delivery of key client professional services projects, ensuring projects are effectively delivered on-time projects and to customer expectations.
• Lead large projects/ programs as needed and delivery ensuring all stakeholders understand respective roles and process best practices
• Ensure that enrollment process improvement work is conducted in compliance with standard processes, policies and procedures and meets mutually agreed upon success criteria and project timeline metrics.
• Define roles and accountabilities for staff, within the group and in the context of the broader process/operation in support of cross-functional efforts.
• Hire for, develop and recognize the experience and knowledge/skills/abilities required for a successful team.
• Provide for the orientation and welcome of new staff.
• Define performance expectations and goals for staff.
• Train and mentor staff on the application of policy and procedures, use of supporting systems/applications, appropriate soft skills: time management, etc.
• Monitor work of individual staff for efficiency, effectiveness and quality. Provide ongoing constructive feedback and guidance to staff.
• Evaluate staff on achievement of goals and deliverables and assessment of competencies. 

Knowledge, Skills and Abilities:  

• Strong knowledge of NC Medicaid and Medicare program elements and compliance requirements.
• Knowledge of project management principles, methods, and techniques.
• Ability to organize, prioritize, and manage multiple complex projects.
• Excellent communication skills both written and oral.
• High proficiency with core office software (Excel, Word, and PowerPoint). Visio skills preferred.
• Strong understanding of managed care legal and regulatory frameworks, healthcare administration models, and internal audit procedures.
• Works with end user to discuss on solutions, concerns and suggestions.
• Provides effective customer service by being courteous, polite and friendly at all times. Acknowledge customers timely in order to determine their need and help the customer resolve the issue or request. Participate in departmental programs that promote and deliver exceptional customer service.
• Performs other duties and special projects as requested 
• Pursue professional growth and development through personal reading, seminars, workshops and professional affiliations to keep abreast of the trends in his/her field of expertise. 
• May be required to travel to perform duties.
• May be required to work outside of normal working hours.
• May be required to work long hours during critical problems or implementations.

Education/Experience Required: 

• Bachelor’s Degree in Healthcare Administration or related field
• 3+ years of experience in a government payor environment with experience in multiple lines of business (Medicare, Medicaid, Healthcare Exchange, etc)
• Progressive leadership experience 
• Electronic Data Interchange 834 file. 

Education/Experience Preferred:  

• Experience delivering results and managing teams/ projects in a health plan setting and/or consulting environment; driving complex programs and activities.
• Managed Care Organization Medicaid eligibility. 

Licensure/Certification Requirements: