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Job Description

Job Summary

Responsible for preparation, processing and maintenance of new members and re-enrollment. Processes and maintains health plan's member and enrollment records, employer's monthly reports, sending membership cards and materials. Verify enrollment status, make changes to records, research and resolve enrollment system rejections. Address a variety of enrollment questions or concerns received via claims, call tracking, or e-mail. Maintain records in the enrollment database.

Knowledge/Skills/Abilities

+ Has direct oversight of enrollment, premium billing and reconciliation processes and all related staff

+ Coaches and mentors direct staff, including goal setting and score card development

+ Monitors and enforces compliance with enterprise-wide processes and develops workflows for all staff to follow

+ Provides monthly reporting to management in support of functional processes

+ Oversees maintenance of processes and procedures for functional areas

+ Complete analysis of data to ensure accuracy and oversight of data entered through both automated process and manual input

+ Ensure quality control of data entered into QNXT and sent to external vendors

+ Oversees and participates in state, federal, and internal audits as needed

+ Participate in process improvement initiatives to improve operations

+ Understands the compliance and regulatory guidelines for each state

+ Maintains relationship with health plan departments to facilitate working relationships

+ Able to work with both corporate and health plan partners as a SME for enrollment during project process and implementation

+ Participation in meetings/calls with the State agencies

+ Strong business writing skills; proficient user of Microsoft Excel, Word. Business math, meeting facilitation skills are a plus

+ Ensures succession plan in place, through coaching/mentoring of next level staff

+ As needed, selects and recruits staff, ensuring candidates are a fit for team in terms of business need and company objectives. Able to take appropriate personnel actions when required

+ Models appropriate professional/business behavior.

+ Direct management and oversight for the Enrollment team, including but not limited to hiring, performance, training, coaching, production and appropriate terminations.

+ Ensures staff is compliant with regulatory and company guidelines, including HIPAA compliance.

+ Responsible for day-to-day functions of the enrollment production, scheduling, monitoring, reporting and taking corrective actions/escalations as needed

+ Primary point of contact for the internal partners, i.e. Medicare Administration, Compliance and Health Plan Operations. Coordinates and facilitates meetings providing appropriate documentation and follow up on action items.

+ Informs next level management of potential risks, provides input on possible mitigation steps and implements changes.

+ Ensures staff follows Enrollment processes and established guidelines; provides appropriate follow up on peer review findings

+ Identifies, defines and communicates opportunities for improvement to senior leadership

+ Strong knowledge of enrollment State, Federal, and business regulatory requirements and strong system knowledge of QNXT and other state specific applications concerning Managed Care Enrollment.

+ Responsible for ensuring timely reconciliation of eligibility files that meet regulatory and health plan requirements.

+ Documents and maintains department workflows, job aids and policies as required to provide training and appropriate workflows.

+ Records and manages enrollment issues and works with other business partners to resolve and communicate solutions as needed. (ticketing)

+ Responsible for communicating and following up on files delayed by state or issues with a file that require state involvement

+ Partners with vendor management team and the external vendor to ensure service level agreements and regulatory requirements are met

+ Considers (thinking bigger picture) downstream and upstream impacts to other department related to Enrollment related changes and coordinate with Center of Excellence team as needed.

Job Qualifications

Required Education

Bachelor's Degree or equivalent combination of education and experience

Required Experience

5-7 years Enrollment-related experience in Managed care or Medicare setting

Preferred Education

Graduate Degree or equivalent combination of education and experience

Preferred Experience

7-9 years Enrollment-related experience in Managed care or Medicare setting

To all current Molina employees: If you are interested in applying for this position, please apply through the intranet job listing.

Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.

Pay Range: $60,415 - $117,809 / ANNUAL

*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.