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Director - Enrollment

Company: HC-Resource
Location: Saint Louis
Posted on: January 15, 2022

Job Description:

Job Summary:

You could be the one who changes everything for our 25 million members. Our Client is transforming the health of our communities, one person at a time. As a diversified, multi-national organization, you'll have access to competitive benefits including a fresh perspective on workplace flexibility.

This role will provide strategic direction for all enrollment functions by providing technical and

leadership support. Oversee enrollment functions to ensure that all efforts are parallel with the

mission and objectives of the plan.
Oversee the Eligibility and Enrollment department staff
Establish working relationships with external sources with Health & Human Services
Commission (HHSC), state enrollment broker, and other local state offices
Collaborate with internal operations teams to identify efficient solutions to meet business needs related to enrollment and facilitate continuous process improvement
Establish and maintain liaison relationships with corporate IT to support and facilitate the common goals and objectives related to enrollment and eligibility services
Design and test new codes sets and processes for new product implementation to include business rule integration and state contract compliance
Manage and establish file interchanges with external vendors and affiliates including the mailhouse
Direct resolution to state complaint trends related to enrollment and eligibility
Represent the health plan in state MIS meetings
Develop and implement a reconciliation process of enrollment and financial records
Direct the eligibility load process while coordinating with the corporate IS department to
resolve issues that arise during the process
Coordinate monthly reconciliation process of remittance files by resolving discrepancies
in the report

Additional Resposibilities:
Lead Enrollment effort regarding Auto Provider Assignment across all Lines of Business (where applicable)
Coordinate with Health Plans on strategy and timing of provider assignment.
Coordinate with Enrollment Platform (UMV) Product Owner team to execute Provider Assignment strategy.
Coordinate with Enrollment, Membership, and Billing User Acceptance Team to assure provider assignment changes are tested appropriately.
Coordinate with Provider Data team and Health Plans on termination of providers and
member moves.
Coordinate with Enrollment, Membership, and Billing Training to ensure consistent approach across all lines of business.
Coordinate with Information Technology Auto Provider Assignment Team
Coordinate with the Enterprise Data Team
Coordinate with the Product Owners for the Enrollment and Provider platform.
Other duties and responsibilities as assigned by leadership
Ensure value capture of APA and corresponding tracking validation with Business
Owners - Health Plans
Coordinate with the Engagement, Data, Productionation & Algorithm leads ensuring business alignment with model design/approach
Tracking and aligning on all IT/Business costs ensuring project aligns with budgeted funding
Engage in Program Increment (PI) to ensure IT resources allocated to Initiative remain dedicated resources

Our Comprehensive Benefits Package:
Flexible work solutions including remote options (local to St. Louis), hybrid work, schedules, and dress flexibility
Competitive pay
Paid Time Off including paid holidays
Health insurance coverage for you and dependents
401(k) and stock purchase plans
Tuition reimbursement and best-in-class training and development

Education/Experience:
Bachelors' degree in related field or equivalent experience.
7+ years of managed care or government programs preferred.
Previous management experience including responsibilities for hiring, training, assigning work, and managing the performance of staff.

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Keywords: HC-Resource, St. Louis , Director - Enrollment, Executive , Saint Louis, Missouri

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