Medicare Enrollment Operations Manager (Remote)

Resp & Qualifications

PURPOSE:
The Manager, Medicare Advantage Billing & Enrollment is responsible ensuring accurate and timely processing of Medicare Advantage enrollment transactions utilizing CMS guidance and CareFirst Advantage, Inc. policies and procedures. This position's responsibilities include the following:

• Managing a team that will review, process, and reconcile Medicare enrollment and disenrollment data, including enrollment applications, prospective and current Medicare member communications, and retroactive processing activity
• Ensures Departments compliance with CMS regulations, guidelines, and timeframes
• Assists with TRR and MRR reconciliation, along with the investigation, correction, and tracking of enrollment transactions as necessary
• Develops and implements departments workflows, policies and procedures, and staff training materials
• Maintains effective relationships and close communication with Medicare Sales Team, Pharmacy, Member Services, and other relevant departments
• Manages Coordination of Benefits validation
• Perform monthly reconciliation between Plans enrollment and CMS Plan Payment Report
• Serves as a subject matter, data analytics, and regulatory reporting expert in Medicare enrollment activities (e.g. enrollment, CMS files processing, reconciliation, regulatory reporting, audit and membership reconciliation

ESSENTIAL FUNCTIONS:

• Achieves operational objectives by contributing information and analysis to strategic plans and reviews; preparing and completing action plans; implementing production, productivity, quality, customer-service standards; identifying and resolving problems; identifying, developing, and implementing system improvements. Meets departmental financial objectives by estimating requirements; preparing an annual budget; scheduling expenditures; analyzing variances; initiating corrective actions.

• Determines operations strategies by conducting needs assessments, performance reviews, capacity planning, and cost/benefit analyses; identifying and evaluating state-of-the-art technologies; defining user requirements.

• Manages employee outcomes by recruiting, selecting, orienting, training, assigning, coaching, counseling, and disciplining employees; communicating job expectations; planning, monitoring, appraising, and reviewing job contributions; planning and reviewing compensation actions; enforcing policies and procedures.

• Develops enrollment and billing systems by establishing technical specifications; developing customer interaction and voice response systems, and voice networks; designing user interfaces; developing and executing user acceptance test plans; planning and controlling implementations.

• Maintains and improves departmental operations by monitoring system performance; identifying and resolving operations problems; managing process improvement and quality assurance programs; installing upgrades.

• Prepares enrollment and billing performance reports by collecting, analyzing, and summarizing data and trends.

• Improves enrollment and billing and management job knowledge by attending educational workshops; reviewing professional and technical publications; establishing personal networks; benchmarking state-of-the-art practices.

SUPERVISORY RESPONSIBILITY:
This position manages people.

QUALIFICATIONS:
Education Level: Bachelors degree in Business or related field OR in lieu of a Bachelor's degree, an additional 4 years of relevant work experience is required in addition to the required work experience

Experience: 5 years progressive experience in operations with time spent in a call center, claims, billing and enrollment, operations environment. 1 year supervisory experience or demonstrated progressive leadership.

Preferred Qualifications:

• Strong presentation skills.
• High proficiency in Microsoft Office programs.
• Excellent written and verbal communication skills.
• Ability to plan, review, supervise, and monitor the work of others.

Knowledge, Skills and Abilities (KSAs)

• Knowledge of call center operations, claims and/or enrollment and billing and work flows.
• Strong presentation skills.
• Highly proficient in Microsoft Office programs.
• Excellent communication skills both written and verbal.
• Ability to plan, review, supervise, and inspect the work of others.

Salary Range: $82,160 - $152,510

Salary Range Disclaimer

The disclosed range estimate has not been adjusted for the applicable geographic differential associated with the location at which the work is being performed. This compensation range is specific and considers factors such as (but not limited to) the scope and responsibilites of the position, the candidate's work experience, education/training, internal peer equity, and market and business consideration. It is not typical for an individual to be hired at the top of the range, as compensation decisions depend on each case's facts and circumstances, including but not limited to experience, internal equity, and location. In addition to your compensation, CareFirst offers a comprehensive benefits package, various incentive programs/plans, and 401k contribution programs/plans (all benefits/incentives are subject to eligibility requirements).

Department

Medicare/Medicaid Enrollment

Equal Employment Opportunity

CareFirst BlueCross BlueShield is an Equal Opportunity (EEO) employer. It is the policy of the Company to provide equal employment opportunities to all qualified applicants without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, protected veteran or disabled status, or genetic information.

Where To Apply

Please visit our website to apply: www.carefirst.com/careers

Federal Disc/Physical Demand

Note: The incumbent is required to immediately disclose any debarment, exclusion, or other event that makes him/her ineligible to perform work directly or indirectly on Federal health care programs.

PHYSICAL DEMANDS:

The associate is primarily seated while performing the duties of the position. Occasional walking or standing is required. The hands are regularly used to write, type, key and handle or feel small controls and objects. The associate must frequently talk and hear. Weights up to 25 pounds are occasionally lifted.

Sponsorship in US

Must be eligible to work in the U.S. without Sponsorship.

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