Director Of Engagement

Overview

Oversees the administrative enrollment and engagement functions for the department. Collaborates on coordination of educational, trainings as it relates to engagement and enrollment activities. Works under general direction.

Compensation:

$137,800.00 - $183,800.00 Annual

• Oversees the management of enrollment and disenrollment of members in managed care systems or value based programs. Reviews internal and external reports/rosters to ensure accuracy of membership and eligibility status. Oversees and/or participates in researching and resolving discrepancies. Monitors subsequent reports and activities to ensure internal/external reconciliation. • Collaborates with leadership on key transformation initiatives to improve operating performance and gain efficiencies. Projects include, but are not limited to, development of new member onboarding processes and sustaining engagement and ongoing member experience. • Identifies areas of opportunity and makes recommendations to better align member experience strategies with product vision, direction, and initiatives. • Analyzes processes, reports problems/issues, and identifies contractual or regulatory performance issues to management. • Development of Program training materials to increase consumer engagement. • Analyzes monthly reports and makes recommendations for change as necessary. • Works in tandem with customer experience department on the creation of consumer journey mappings across the CMO. • Prepares and analyzes reports regarding enrollment, engagement, referral and membership activities on a monthly basis for use by management to monitor/project plan growth, membership, trends and their impact on financial, operational and programmatic areas. • Stays abreast of customer service industry trends and ensures VNS Health policies and procedures reflect the changes in the industry. • Performs all duties inherent in senior managerial role. • Develop strategies to include both workforce and member/engagement and satisfaction. • Participates in special projects and performs other duties as assigned. • For VNS Health Plans only: • Oversees Medicare Part D enrollment and disenrollment reconciliation activities including TROOP data transfer and Plan-to-Plan (P2P) financial reconciliation of pharmacy expenses per CMS regulations. • Communicates status and determinations from HRA review to Enrollment Unit and service delivery staff. • Oversees enrollment, membership and disenrollment activities for VNS Health Plans Medicare products through CMS reports, TPA performance reports and annual on-site review of operations. Monitors Medicaid eligibility status for VNS Health Plans Medicare members who have lost coverage to determine necessary actions for continued enrollment or disenrollment. Assists TPA in resolving member eligibility and payment issues. • Oversees Part D enrollment and disenrollment reconciliation activities, including PDE reconciliation and sending/ receiving TROOP data. Manages Part D receivables and payables through P2P reports. Coordinates with Health Care Analyses Unit and Finance Department in TROOP database maintenance and Part D financial reports. • Manages coordination of benefits (“COB”) for members who have primary payers or who have COB possibility. Ensures updates and changes to COB are made in managed care system and clinical system. Monitors Medicare system to identify patient member enrollment into Medicare HMO and ensures communication, coordination and reconciliation of benefits/claims with VNS Health Plans claims unit. • Approves staff training, hiring, promotions, evaluations, terminations, and salary actions. • Reviews data for accuracy prior to submission to state and federal agencies. • Oversees processing of payments for payables/initiates collection of receivables from other organizations. • Supervises staff in managing vendor communications to ensure timely/accurate dissemination and transmission of member eligibility information to network service managers (e.g., dental). • Participates in special projects and performs other duties as assigned.
Qualifications
Education:
Bachelor's Degree in Business, Health Administration or related discipline required Master's Degree in Business Administration or Health Administration or equivalent preferred
Work Experience:
Minimum of six years of progressively responsible operations experience required Experience in the health insurance industry preferred Minimum of five years of managerial experience preferred Demonstrated knowledge of Engagement or enrollment operations required Excellent analytic, oral, written and interpersonal communication skills required Excellent personal computer skills, including MS Excel and Word required