At Virginia Premier, we are building an industry leading health care organization through dedicated teams that have heart, provide top-notch quality member services and embrace our mission of inspiring healthy living within the communities we serve. Our vision is to connect people to innovation, quality and affordable health care for all phases of life.
The Director of Enrollment Operations is responsible for directing the operations of the Enrollment Department for all product lines to include Medicaid, Medicare and other essential departments to ensure all functions related to eligibility and enrollment transactions are performed within the established quality and quantity standards.
This position will have a direct view into how Virginia Premier is enrolling members, maintaining membership information, managing premium billing and interacting with DMAS and CMS (regulatory agencies).
Primary owner of the enrollment process, staff and date; empowered to drive technology advancements that will support an effective member data management operation.
Demonstrate comprehensive understanding of DMAS and CMS member enrollment contractual requirements.
Set strategic direction for Enrollment activities.
Insure the proper loading and data validation of all member enrollment related files to include, but not limited to 834’s, Wipro Eligibility Files and 820 payment files
Be the primary owner of the enrollment capabilities platform, empowered to continue to drive technology advancements that will support a more effective member experience and more efficient operation.
Insure that Enrollment external vendor files are sent to external vendors, loaded and validated in a timely manner
Insure that enrollment related member materials are mailed in the time-frames outlined by DMAS and CMS contractual requirements.
Develop an expertise on all enrollment related platforms to include IDX and QNXT.
Provide guidance and direction to insure proper testing of vendor files and system changes as part of the enrollment processes.
Be an active participant in Annual Enrollment Period (AEP) activities and lead all enrollment related AEP planning and operations.
Identify and implement cost management strategies and process improvement initiatives
Insure the proper training of Enrollment Managers, Analyst and Enrollment team members
Perform other managerial duties as required.
Responsible for maintaining the Medicaid and Medicare Enrollment Department performance objectives while ensuring all enrollment process schedules are met.
MINIMUM EDUCATION REQUIREMENTS
Bachelor’s degree; MBA is a plus
SPECIAL KNOWLEDGE AND/OR SKILLS
Excellent understanding of health care insurance markets, and health plan business operations
Excellent oral & written communication skills
Ability to manage multiple projects while meeting deadlines and achieving business goals
Ability to supervise staff and promote successful performance.
Highly analytical and creative thinker, bias to action, practical, with a passion for business problems and emerging technologies.
Very collaborative, strong track record leading and executing on cross-functional projects.
Proven ability to work independently while managing multiple tasks and deadlines
Candidate will be proficient with data analysis or business analysis in a health care environment.
Minimum of 5+ years of health plan or member enrollment leadership experience with a strong background in innovation and technology
Physical health sufficient to meet the ergonomic standards and demands of the position
All qualified applicants will receive consideration for employment without regard to age, race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or protected veteran status. EOE
Our mission is to inspire healthy living within the communities we serve!Position Description »