Job Information
Molina Healthcare Mgr, Enrollment in Meridian, Idaho
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
Has direct oversight of enrollment, premium billing and reconciliation processes and all related staff
Coaches and mentors direct staff, including goal setting and score card development
Monitors and enforces compliance with enterprise-wide processes and develops workflows for all staff to follow
Provides monthly reporting to management in support of functional processes
Oversees maintenance of processes and procedures for functional areas
Complete analysis of data to ensure accuracy and oversight of data entered through both automated process and manual input
Ensure quality control of data entered into QNXT and sent to external vendors
Oversees and participates in state, federal, and internal audits as needed
Participate in process improvement initiatives to improve operations
Understands the compliance and regulatory guidelines for each state
Maintains relationship with health plan departments to facilitate working relationships
Able to work with both corporate and health plan partners as a SME for enrollment during project process and implementation
Participation in meetings/calls with the State agencies
Strong business writing skills; proficient user of Microsoft Excel, Word. Business math, meeting facilitation skills are a plus
Ensures succession plan in place, through coaching/mentoring of next level staff
As needed, selects and recruits staff, ensuring candidates are a fit for team in terms of business need and company objectives. Able to take appropriate personnel actions when required
Models appropriate professional/business behavior.
Direct management and oversight for the Enrollment team, including but not limited to hiring, performance, training, coaching, production and appropriate terminations.
Ensures staff is compliant with regulatory and company guidelines, including HIPAA compliance.
Responsible for day-to-day functions of the enrollment production, scheduling, monitoring, reporting and taking corrective actions/escalations as needed
Primary point of contact for the internal partners, i.e. Medicare Administration, Compliance and Health Plan Operations. Coordinates and facilitates meetings providing appropriate documentation and follow up on action items.
Informs next level management of potential risks, provides input on possible mitigation steps and implements changes.
Ensures staff follows Enrollment processes and established guidelines; provides appropriate follow up on peer review findings
Identifies, defines and communicates opportunities for improvement to senior leadership
Strong knowledge of enrollment State, Federal, and business regulatory requirements and strong system knowledge of QNXT and other state specific applications concerning Managed Care Enrollment.
Responsible for ensuring timely reconciliation of eligibility files that meet regulatory and health plan requirements.
Documents and maintains department workflows, job aids and policies as required to provide training and appropriate workflows.
Records and manages enrollment issues and works with other business partners to resolve and communicate solutions as needed. (ticketing)
Responsible for communicating and following up on files delayed by state or issues with a file that require state involvement
Partners with vendor management team and the external vendor to ensure service level agreements and regulatory requirements are met
Considers (thinking bigger picture) downstream and upstream impacts to other department related to Enrollment related changes and coordinate with Center of Excellence team as needed.
Job Qualifications
Required Education
Bachelor's Degree or equivalent combination of education and experience
Required Experience
5-7 years Enrollment-related experience in Managed care or Medicare setting
Preferred Education
Graduate Degree or equivalent combination of education and experience
Preferred Experience
7-9 years Enrollment-related experience in Managed care or Medicare setting
To all current Molina employees: If you are interested in applying for this position, please apply through the intranet job listing.
Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.
Pay Range: $67,725 - $141,371 / ANNUAL
*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.