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Location:

Avera Health Plans

Worker Type:

Regular

Work Shift:

Primarily days with possible weekends/evenings/holidays (United States of America)

Position Highlights

You Belong at Avera

Be part of a multidisciplinary team built with compassion and the goal of Moving Health Forward for you and our patients. Work where you matter.

A Brief Overview

The Avera Health Plan Manager of Enrollment is responsible for overseeing and managing the enrollment process, ensuring compliance with regulations, accuracy of data, and timely processing. This role involves overseeing internal and external stakeholders to ensure accurate and complete enrollment data (including weekly and monthly reconciliation activities) and to resolve enrollment-related issues. This role will support in meeting and exceeding Avera's service and growth goals. The Manager of Enrollment will ensure compliance with all federal and state laws, regulations and contractual agreements are achieved. The Manager supervises a team of professionals focused on the successful preparation, processing and maintenance of group and member eligibility and enrollment services, third party coordination of benefit determinations and COBRA. This position maintains knowledge and deep understanding of federal and state laws, and regulations, as well as various applications and systems used, developing policy, procedure, and work instructions to aid staff and ensure compliance. Performance standards and operational controls will be defined and continuously evaluated for process improvement to ensure consist high quality outcomes that are scalable. This position is responsible for executing on Avera Health Plans' strategic initiatives, completing assigned projects and tasks, and achieving goals and objectives within established timelines. This role requires open communication and collaboration with other health plan leaders, and the successful management of vendor relationships.

What you will do

+ Manages team responsible for maintaining member and group enrollment and reconciliation processes and COBRA activities, overseeing initial loading and processing of member and group data into appropriate eligibility systems and ongoing maintenance of enrollment data. Ensures accurate and timely processing of information, compliance with HIPAA regulations and a good customer experience.

+ Maintains the overall integrity of enrollment and COBRA processes, including policies and procedures, performance standards and operational work instructions to comply with federal and state laws and regulations, and contractual requirements. Participates in state, federal, and internal audits as needed.

+ Establish and maintain performance standards, operational controls, and continuously evaluate and improve upon metrics, processes and procedures to optimize performance and achieve business objectives.

+ Responsible for ongoing reconciliation activities, required by government entities and employers. Leads team in analyzing transactional data, prioritizing discrepancies and providing timely and accurate resolution.

+ Plans for and leads department-level upgrades, developing and executing user acceptance test plans; planning and controlling implementations.

+ Oversees technical development and optimizations of enrollment and COBRA applications and software solutions. Understands and informs process workflow and maintains technical specifications for the enrollment user interfaces.

+ Is accountable for quality and performance standards pertaining to the accurate and timely processing of member ID cards and membership materials.

+ Responsible for managing assigned vendor relationships and holding vendors accountable to service level agreements.

+ Represents the Enrollment department, serving as the subject matter expert and liaison in meetings, projects and training.

+ Address and resolve enrollment related issues timely and communicates effectively.

+ Responsibilities include interviewing, hiring, developing, training, and retaining employees; planning, assigning, and leading work; appraising performance; rewarding and coaching employees; addressing complaints and resolving problems.

Essential Qualifications

The individual must be able to work the hours specified. To perform this job successfully, an individual must be able to perform each essential job function satisfactorily including having visual acuity adequate to perform position duties and the ability to communicate effectively with others, hear, understand and distinguish speech and other sounds. These requirements and those listed above are representative of the knowledge, skills, and abilities required to perform the essential job functions. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential job functions, as long as the accommodations do not cause undue hardship to the employer.

Required Education, License/Certification, or Work Experience:

+ Bachelor's Health, Accounting, Finance, Business or related field.

+ 4-6 years Experience in finance, reporting and reconciliation, or regulatory compliance in a health insurance environment.

Preferred Education, License/Certification, or Work Experience:

+ 1-3 years Management experience, including excellent communication, interpersonal and organizational skills.

+ IT Systems and/or data exchange experience.

+ Strong knowledge of enrollment processes, regulations, and compliance requirements.

+ Experience with project management and process improvement.

Expectations and Standards

+ Commitment to the daily application of Avera’s mission, vision, core values, and social principles to serve patients, their families, and our community.

+ Promote Avera’s values of compassion, hospitality, and stewardship.

+ Uphold Avera’s standards of Communication, Attitude, Responsiveness, and Engagement (CARE) with enthusiasm and sincerity.

+ Maintain confidentiality.

+ Work effectively in a team environment, coordinating work flow with other team members and ensuring a productive and efficient environment.

+ Comply with safety principles, laws, regulations, and standards associated with, but not limited to, CMS, The Joint Commission, DHHS, and OSHA if applicable.

Benefits You Need & Then Some

Avera is proud to offer a wide range of benefits to qualifying part-time and full-time employees. We support you with opportunities to help live balanced, healthy lives. Benefits are designed to meet needs of today and into the future.

+ PTO available day 1 for eligible hires.

+ Free health insurance options, for full-time single coverage on Avera High Deductible Health Plan

+ Up to 5% employer matching contribution for retirement

+ Career development guided by hands-on training and mentorship

_Avera is an Equal Opportunity Employer - Qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability, Veteran Status, or other categories protected by law. If you are an individual with a disability and would like to request an accommodation for help with your online application, please call 1-605-504-4444 or send an email to_ [email protected]_ _._

At Avera, the way you are treated as an employee translates into the compassionate care you deliver to patients and team members. Because we consider health care a ministry, you can live out your faith, uphold the dignity and respect of all persons while not compromising high-quality services. Join us in making a positive impact on moving health forward.

The policy of Avera to provide opportunities for all qualified employees or applicants without regard to disability and to provide reasonable accommodations for all employees or applicants who may be disabled. Avera is committed to ensuring compliance in accordance with the Americans with Disability Act. For assistance, please contact HR Now at 605-504-4444.

Additional Notices:

For TTY, dial 711

Avera is an Equal Opportunity/Affirmative Action Employer: Minority/Female/Disabled/Veteran/Sexual Orientation/Gender Identity.