Integra Managed Care
The Enrollment Manager serves as a proxy for the Director of Enrollment, overseeing the activities and employees of the Enrollment department while ensuring its processes operate smoothly. The Enrollment Manager also works with customers, vendors, and with City and State agencies to resolve eligibility issues in order for the plan to continue receiving payment for medical services provided.
Assisting the Director of Enrollment with staff management, addressing performance and attendance issues as appropriate.
Directing, reviewing, monitoring, and controlling the Enrollment reconciliation operation with efficiency and effectiveness.
Directing the design/revision and implementation of internal departmental systems and procedures.
Directing the submission and monitoring of daily, weekly and monthly inventory reports to determine departmental efficiency and maintain the integrity of the enrollment file.
Overseeing the strategic future planning of the enrollment function. Ensuring the Enrollment function has sufficient capacity and growth to support new business.
Ensuring that prospective enrollees are appropriately screened to meet eligibility requirements within regulatory timelines.
Leading the enrollment team to ensure timely and accurate completion of all required eligibility documents, accurate recording of assessments, and guaranteeing productivity standards.
Leading and coordinating interdepartmental projects with other areas of the organization; including Retention, IT, Marketing departments, Compliance, and Provider Relations.
Working closely with the Local department of Social Service, HRA, and Maximus to ensure timely submissions and resolution of eligibility issues, as well as establishing departmental goals and ensuring quality goals are met.
Analyzing workflows, identifying deficiencies, and developing more efficient processes.
Preparing enrollment analysis and enrollment reports for the Director of Enrollment.
Overseeing surplus billing and working closely with the Finance department in the reconciliation of capitation payments.
Directing the implementation of NYS Medicaid and Medicare regulations and related products.
Serving as a subject matter expert and coordinating departmental procedures.
Ensuring compliance with company and statutory policies.
Developing departmental policy and procedural documentation.
Ensuring the required member mailings are sent in a timely fashion.
Leads a team; responsible for strategic and proactive hiring, performance management, and coaching/mentoring/training to enhance professional development.
Bachelors Degree preferred
5-7 years progressive work experience in business or health operations
Preferred experience with managed care and 3-4 years supervisory experience
Intermediate computer knowledge (Excel, Word, Outlook) ACD system, scanning and creating PDF files, and UAS-NY
Experience in the health care industry
Some knowledge of Medicare
Strong interpersonal skills and the ability to establish a rapport with all levels of an organization
Strong customer service skills
Exceptional written and verbal communication skills
Expert knowledge of Medicaid reimbursement methodologies
Ability to convey complex or technical information in a manner that is easy to understand
Understand and interpret reimbursement policy standards
Strong leadership skills
Integra is an Equal Opportunity Employer and prohibits discrimination or harassment based on any characteristics protected by the laws or regulations in the locations where we operate.
If this opportunity sounds exciting and challenging to you, please click “Apply” now!