Manager, Enrollment Operations (Health Plan Enrollment experience required)

CareSource; Northern (KY); Hybrid; USD 83,000 - 133,000; Full time

Job summary

CareSource seeks a Manager, Enrollment Operations to lead the Enrollment team and ensure the department meets its goals and CareSource standards. The role requires knowledge of end-to-end enrollment processes, regulatory compliance, and data-driven improvement initiatives.

The candidate will oversee data reconciliation, eligibility processing, and audit engagements while guiding staff development and performance management in a dynamic health plan environment.

Qualifications

• Bachelor's degree required.
• Three (3) years of leadership/management experience.
• Three (3) years of enrollment/reconciliation/call center experience.

Responsibilities

• Provide leadership and direction to the Enrollment team to ensure goals and standards are met.
• Ensure timely, accurate and high-quality outputs for internal customers.
• Oversee enrollment data reconciliation and eligibility processing for assigned lines of business.
• Ensure compliance with regulatory requirements assigned to the team.
• Manage enrollment technology and processes involving 834 or DTRR file processes and related PSOs.
• Oversee enrollment audits and implement corrective actions as needed.
• Analyze department performance data and recommend process improvements.
• Mentor and develop staff; lead performance evaluations and coaching.

Skills

Leadership/people management

Enrollment processes

HIPAA & regulatory compliance

Facets subscriber setup

Benefits eligibility COB

Data analysis

Education

Bachelor's degree

Tools

Facets

Customer Service application

Job description

Job Summary:

The Manager, Enrollment Operations provides leadership and direction to the Enrollment team to ensure the goals and standards of the department, and CareSource, are met.

Essential Functions:

• Understand enrollment end to end processes and able to comprehend impact of any enrollment issues to various departments in the organization
• Responsible for quality of outputs and operational efficiency of the team
• Responsible for managing staff to ensure timely, accurate and high quality completion of service items for internal customers
• Oversee the financial and member enrollment reconciliation for assigned lines of business
• Oversee vendor eligibility extract processes to ensure accurate and timely processing of eligibility data
• Responsible for complying with and meeting all regulatory requirements assigned to their team
• Manage enrollment technology and process analysts and associated activities involving 834 or Daily Translation Reply Report (DTRR) file processes and departmental P&PS's
• Manage all enrollment audit engagements to ensure accurate and timely response. As necessary, develop and implement corrective action plans to address audit results
• Gather, analyze, and report data related to the performance of the department and make recommendations for process improvement(s)
• Actively participate in ongoing development of new products and technologies
• Manage daily operations and projects through effective allocation of resources
• Develop and maintain an in-depth knowledge of the company’s business and regulatory environments
• Incorporate effective change and risk management controls
• Responsible for hiring, training, coaching and developing direct reports including completing performance appraisals and disciplinary actions
• Mentor team leads and team members to produce consistent, high quality deliverables
• Performs any other job related duties as requested.

Education and Experience:

• Bachelor's degree required
• Equivalent years of relevant work experience may be accepted in lieu of required education
• Three (3) years of leadership/management experience required
• Three (3) years of enrollment/reconciliation/call center experience required

Competencies, Knowledge and Skills:

• Strong understanding of health plan enrollment processes
• Expert proficiency in Facets subscriber and member setup, benefits eligibility [including COB], and proficiency in the Customer Service application is preferred
• Knowledge of Medicaid, Medicare, and Dual coverage programs, including enrollment requirements and regulatory compliance
• Understanding of HIPAA 834, EDI 270/271, DTRR, MMR, and other industry-standard enrollment files and data exchange processes
• Knowledge of enrollment reconciliation is preferred
• Strong Knowledge of regulatory reporting and compliance requirements is preferred
• Proficient in use of online services to verify member eligibility for each CareSource program, and internal and external eligibility search functions
• Effective people management/leadership skills
• Strong knowledge of database management desired
• Knowledge of working with IT teams and providing requirements
• Ability to effectively prioritize and execute tasks in a high-pressure environment
• Ability to defuse tension and manage conflict among and between teams and members
• Advanced communication skills (both written and verbal) and ability to work with multi-disciplinary departments across the organization
• Excellent mentoring and coaching skills
• Persuasive, encouraging, and motivating
• Excellent decision making/problem solving skills
• Strong critical thinking and listening skills
• Analytical thinking
• Leads by example
• Actively gathers appropriate level of participation and input to decision-making and fosters it within teams
• Focuses and aligns actions and decisions on ways to enhance service and Member experience

Licensure and Certification:

• None required

Working Conditions:

• General office environment; may be required to sit or stand for extended periods of time
• Travel is not typically required

Salary

$83,000.00 - $132,800.00 CareSource takes into consideration a combination of a candidate's education, training, and experience as well as the position's scope and complexity, the discretion and latitude required for the role, and other external and internal data when establishing a salary level. In addition to base compensation, you may qualify for a bonus tied to company and individual performance. We are highly invested in every employee's total well-being and offer a substantial and comprehensive total rewards package.

Salary

Organization Level Competencies- Fostering a Collaborative Workplace Culture- Cultivate Partnerships- Develop Self and Others- Drive Execution- Influence Others- Pursue Personal Excellence- Understand the Business

This job description is not all inclusive. CareSource reserves the right to amend this job description at any time. CareSource is an Equal Opportunity Employer. We are dedicated to fostering an environment of belonging that welcomes and supports individuals of all backgrounds.

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