Manager Service Operations - Medicare
Bcidaho

Responsible for managing and efficiently coordinating the day-to-day operations of Medicare Advantage enrollment/disenrollment process while ensuring compliance with CMS guidelines. The Manager ensures adherence of daily productivity, quality and regulatory guidelines within the Enrollment and Billing Services (EBS) department. Responsible for reports, policies, and procedures. Develops strategic plans and procedures in support of operational effectiveness, customer service goals and objectives. Implements initiatives to increase provider and member satisfaction. Oversees analysis of key performance measurements to identify areas in need of training and improvement, as well as the identification of potential workflow improvements.

Requirements

Education: Bachelor's Degree or equivalent work experience (Two years' relevant work experience is equivalent to one-year college)

Experience: 7 years' relevant experience to include leadership experience and:

• CMS Enrollment/Disenrollment experience with Data Validation and Corrective Action Plans. Expert on CMS Chapter 2. Understanding of the process flow of CMS member data into BCI membership system
• Communication Proficiency, with thoroughness and attention to detail
• Teamwork Orientation
• Technical Capacity and Problem Solving
• Able to lead, organize, plan and coordinate tasks, set and achieve team goals and objectives

Areas under responsibility include:

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  Enrollment, Disenrollment, PBP Changes and Cancellation notices issuance, CMS Submissions, liaison for Membership Reconciliation, Billing and Collections. Oversight, accuracy and timeliness of operations including the analysis and appropriate decisions for enrollments process.
  
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  Adherence to CMS policies, procedures and CMS guidance for enrollment/disenrollment process of the MA, MA-PD and PDP applications. Provide support on CMS or any Regulatory Agency auditing process.
  
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  Creation and/or monitoring of daily operational reports to ensure SLA and CMS timeliness measures are being met. Follow the monthly close process, including any reporting requirements. On an annual basis prepare enrollment readiness, enrollment area, and staff for Annual Enrollment Period, including enrollment forms, letters, and applicable updates to other enrollment materials.
  
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  Oversee administrative functions, including tracking of member Medicare eligibility, retro-transaction, audits, letter creation and maintenance, LEP, LIS, recertification, and coordination of documentation in member records, and TRR transactions. Ensure the privacy and confidentiality of the protected health information (PHI) and corporate information accessible as part of the position's functions. Ensure ID Card regulatory requirements updates and send them to enrollees timely.
  
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  Administration, tracking and resolution of enrollment-related issues. Analyze, provide input, feedback, and guidance on the resolution of member enrollment inquiries and service requests. Reconciles membership and works to develop checks and balances system.
  
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  Monitoring and assuring that follow-up re-evaluation activities take place when deficiencies are identified and recommendations for corrective action have been made. Provide education to members and vendors regarding compliance; complete an annual review of department policies and procedures and make recommendations for updates based on changing needs or trends; assisting in preparing the annual program evaluation and work plan.
  
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  Responsible for Enrollment system configuration of benefits, enrollment applications, EDV and transactions processing.
  
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  Manage all vendor defects and transmittals, discuss changes, provide test strategy input, lead staff in testing efforts and perform post implementation review
  
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  Participate in the implementation of new products and services, including the development of operational procedures, best practices, and methodologies, in compliance with corporate and regulatory directives and standards.
  
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  Establish priorities and oversee goal-attaining, innovative processes aligned to Company's strategic plan and objectives. Ensure efficient, emphatic, and excellent services are consistently rendered. Evaluate the performance and execution of department staff under supervision. Identify educational needs and coordinate staff education on process and procedures regulations. Ensure staff adheres to all the enrollment operational policies and procedures.
  
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  Coordinate with the other company divisions to synchronize information, operations, projects, and campaigns.
  
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  Assist in any special projects and/or work assigned to the Enrollment Management team as needed.
  

Reasonable accommodations

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed above are representative of the knowledge, skill and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

We are an Equal Opportunity Employer and do not discriminate against any employee or applicant for employment because of race, color, sex, age, national origin, religion, sexual orientation, gender identity, status as a veteran, and basis of disability or any other federal, state or local protected class.

This job has expired.