Director, Enrollment (Duals) - REMOTE

Molina Healthcare; Long Beach (CA); Remote; USD 150,000 - 200,000; Full time

Job summary

An established industry player is seeking a dedicated Enrollment Manager to oversee the preparation and maintenance of member records. This role involves ensuring compliance with enrollment processes, addressing member inquiries, and maintaining accurate data within the enrollment database. With a focus on Duals and Medicare enrollment, you will bring your extensive experience to a team that values accuracy and efficiency. Join a forward-thinking organization where your expertise will directly impact the quality of service provided to members, making a difference in their healthcare experience.

Qualifications

• 7-9 years experience in Duals / Medicare enrollment is required.
• Graduate degree or equivalent education and experience is essential.

Responsibilities

• Prepare and maintain member and enrollment records for health plans.
• Verify enrollment status and resolve system rejections.

Skills

Enrollment Oversight

Compliance Monitoring

Data Accuracy

Policy Maintenance

Subject Matter Expertise

Education

Graduate Degree

Job description

Job Description

Job Summary
Responsible for preparation, processing and maintenance of new members and re-enrollment. Processes and maintains health plan's member and enrollment records, employer's monthly reports, sending membership cards and materials. Verify enrollment status, make changes to records, research and resolve enrollment system rejections. Address a variety of enrollment questions or concerns received via claims, call tracking, or e-mail. Maintain records in the enrollment database.

Knowledge/Skills/Abilities

• Holds general oversight of enrollment and premium staff at each plan site within defined region. This may include employee reviews, coaching sessions and disciplinary actions.
• Monitors and enforces compliance with company-wide reconciliation processes.
• Ensures that delivery of enrollment / premium related data is accurate for defined region.
• Subject matter expert for projects and / or new business related to areas of oversight.
• Oversees maintenance of policies and standard operating procedures.

Job Qualifications

Required Education
Graduate Degree or equivalent combination of education and experience.

Required Experience
7-9 years Duals / Medicare enrollment experience.

Preferred Experience
10+ years Medicaid and Medicare Regulations.