Enrollment Operations Leader | Quality & Compliance

CareSource; Kentucky; Hybrid; USD 83,000 - 133,000; Full time

Job summary

CareSource in Kentucky is seeking the Manager, Enrollment Operations to lead the Enrollment team, ensuring the department meets CareSource's standards and goals. The role covers end-to-end enrollment processes, quality outputs, and timely completion of client and internal requests.

You will oversee reconciliation for multiple business lines, manage 834/DTRR related processes, and ensure regulatory compliance across programs while mentoring staff and driving data-driven improvements.

Qualifications

• Bachelor's degree required
• Three (3) years of leadership/management experience required
• Three (3) years of enrollment/reconciliation/call center experience required
• Strong understanding of health plan enrollment processes
• Knowledge of Medicaid, Medicare, and Dual coverage programs
• Understanding HIPAA 834, EDI 270/271, DTRR, MMR enrollment files
• Proficient in enrollment reconciliation and regulatory reporting
• Excellent communication and leadership skills

Responsibilities

• Lead Enrollment team to meet department goals and standards
• Ensure quality outputs and operational efficiency
• Manage staff for timely, accurate service item completion
• Oversee enrollment reconciliation for assigned lines of business
• Oversee vendor eligibility extract processes for accurate data
• Ensure compliance with regulatory requirements
• Manage 834 and Daily Translation Report file processes
• Develop and implement corrective action plans from audits
• Analyze data and recommend process improvements
• Mentor and develop team members to deliver high quality results

Skills

Enrollment leadership

Enrollment processes

Regulatory compliance

HIPAA 834

Team leadership

Data analysis

Vendor management

Facets knowledge

Communication

Regulatory reporting

IT liaison

Education

Bachelor's degree

Tools

Facets system

EDI 270/271

DTRR

Job description

CareSource in Kentucky is seeking the Manager, Enrollment Operations to lead the Enrollment team, ensuring the department meets CareSource's standards and goals. The role covers end-to-end enrollment processes, quality outputs, and timely completion of client and internal requests.

You will oversee reconciliation for multiple business lines, manage 834/DTRR related processes, and ensure regulatory compliance across programs while mentoring staff and driving data-driven improvements.