This job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee for this job. Duties, responsibilities and activities may change at any time with or without notice.
Manager, Eligibility
Location
United States
Posted
56 days ago
Salary
0
Seniority
Lead
No structured requirement data.
Job Description
Manager, Eligibility
GLOBALHEALTH HOLDINGS LLC
Role Description The Manager, Eligibility position reports directly to the Director, Enrollment & Fulfillment and is primarily responsible for managing enrollment activities to facilitate and enhance the company’s operational and financial goals. Responsibilities include: - Preparation and timely processing of enrollment applications, management, and maintenance in accordance with CMS regulations. - Overseeing enrollment activities and reconciliation. - Strong knowledge of the Enrollment process along with State, Federal, and business regulatory requirements. - Ensuring quality control of data entered into membership database and sent to external vendors. - Overseeing and participating in state, federal, and internal audits, as needed. - Accurate and timely dissemination of eligibility data to the network, ancillary providers, and internal systems. - Partnering with external vendors for contracts related to Medicare enrollment file transactions to CMS, ID Card printing, and mailing. - Overseeing external vendors on the development and implementation of initiatives to improve retention efforts among current members. - Ensuring staff compliance with regulatory and company guidelines, including HIPAA compliance. - Partnering with the Director, Enrollment and Fulfillment to establish departmental goals and objectives. - Developing performance competencies and metrics aligned with business goals. - Managing the auditing of enrollment and disenrollment information data. - Creating and implementing policies, procedures, workflows, and job aides for training. - Reconciling monthly payments and discrepancies between data submitted to CMS and GlobalHealth records. - Coordinating and managing the generation and mailing of necessary correspondence relating to enrollment. - Communicating and following up on files delayed by CMS or State. - Reviewing and analyzing all State agency reports/rosters/premium files for eligibility validation. - Performing other duties as assigned. Qualifications - Bachelor’s Degree required. - 3+ years Enrollment Processing related experience in Managed Care or Medicare setting. - Experience processing CMS Transaction Files. - Proficient with Microsoft Office applications, including Word, Excel, Outlook, and various database applications. - Detail-oriented with problem-solving abilities. - Strong and effective verbal and written communication skills. - Exemplary interpersonal and customer service skills. - Good judgment, organization, prioritization, and time management skills. - Proven leadership with staff, projects, and management. - Strategic thinking abilities and analytical skills. - Ability to present written information and findings clearly. Requirements - Strong understanding of eligibility and enrollment transactions in health care/managed care industry. - Ability to perform essential job functions with a high degree of independence and flexibility. - Ability to function effectively under stress and conflicting demands. - Ability to multi-task, set priorities, and manage time effectively. - Intermediate accurate keyboarding skills. - Ability to function in a fast-paced, detail-oriented environment. - Efficiency in MS Office Suite (Word, Outlook, Excel). Work Environment Work is normally performed in a professional office setting with a moderate noise level. It involves standing and walking for brief periods, but most duties are performed from a seated position. Normal vision and hearing are required, along with finger dexterity and eye-hand coordination to operate a computer keyboard. Travel No travel is expected for this position. Supervisory Responsibility This position reports directly to the Director, Enrollment & Fulfillment and is responsible for the supervision of the Enrollment team. Expected to work collaboratively with other departments. Other Duties This job description is not designed to cover or contain a comprehensive listing of activities, duties, or responsibilities that are required of the employee for this job. Duties, responsibilities, and activities may change at any time with or without notice.
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