The individual will have oversight for eligibility, enrollment and billing functions for Individual (On and Off Exchange), Medicare Advantage, Small Group, and Uniformed Services Family Health Plans, for a multi-state health insurer. Primary responsibilities include management of both internal and external (via vendor) processes supporting enrollment, membership reconciliation, data accuracy, discrepancy resolution, billing, payment, collections, financial reconciliation, and all related member correspondence and service. The successful candidate will have extensive experience in a functional leadership role, and familiarity with both commercial and regulated health insurance. This position is responsible for managing and coordinating team efforts toward a specific service delivery function of the health plans. The position provides coaching, feedback, and corrective action to health plan associates where needed. The Director of Eligibility, Enrollment, and Billing is also responsible for leading discussions with the applicable regulatory agencies and will act as the primary liaison between the CHRISTUS Health Plan and any third party vendors providing relevant services.
Manages multiple teams responsible for preparing, processing and maintaining new member or group enrollments, and overseeing the loading of new members or group data into appropriate eligibility systems.
Collaborates with other service function leaders to prioritize emerging issues and coordinate timely resolutions, including Call Center Operations and Complaints & Appeals.
Has oversight for ongoing data reconciliation activities, with both government entities and employers; will lead teams in analyzing transactional data, prioritizing discrepancies and providing timely and accurate resolution.
Establishes and executes a detailed renewal plan for all lines of business, focusing on member retention and member satisfaction.
Primary liaison to external vendors supporting enrollment and/or billing, with oversight to both day-to-day functions and ad hoc needs.
Oversees the documentation of business requirements to enhance or expand operational efficiencies supporting enrollment and billing; provides input to cross-functional prioritization meetings, to establish both tactical and strategic improvements.
Manages staff in daily functions to ensure all processes are completed within regulatory and quality standards
Meets and exceeds department quality audits and provide coaching to team members
Oversees internal enrollment agents, trains and supervises agents on the enrollment process
Handle all escalations courteously, politely and professionally
Act as back-up support for departmental managers and leadership as needed for meetings and other departmental responsibilities
Serves as the subject matter expert for the enrollment process for multiple plans, including Medicare Advantage, Small Group, Uniformed Services Family Health Plan, and Health Insurance Exchange.
Acts as the liaison with federal and state contacts on eligibility and enrollment topics
Supports external audits focused on enrollment and/or billing data and functions, as needed.
Perform other duties as assigned
College degree and/or minimum of 10 years of healthcare supervisory experience.
Strong knowledge and experience with Medicare policies and standards of eligibility.
Strong knowledge and experience with Individual and Small Group enrollment, rating and billing regulations, post-ACA.
Must have strong analytical, and writing skills
Demonstrated maturity and capacity to navigate a complex structure and respond to shifting and fluid priorities
Excellent judgment, the ability to communicate openly among colleagues at all levels, a "hands-on" approach, and the ability to think strategically and produce strong results
Ability to prioritize, work on tight deadlines and work on multiple projects
Demonstrated success with building and guiding a team to develop and monitor enrollment, eligibility and billing functions within the health plan
CHRISTUS HEALTH is an international Catholic, faith-based, not-for-profit health system comprised of almost more than 600 services and facilities, including more than 60 hospitals and long-term care facilities, 350 clinics and outpatient centers, and dozens of other health ministries and ventures. CHRISTUS operates in 6 U.S. states, Colombia, Chile and 6 states in Mexico. To support our health care ministry, CHRISTUS Health employs approximately 45,000 Associates and has more than 15,000 physicians on medical staffs who provide care and support for patients. CHRISTUS Health is listed among the top ten largest Catholic health systems in the United States.