Job Description

Category:
Management/ Professional

Facility:
Steward Health Care Network

Department:
Steward Health Care Network

Req Number:
55308

Job Details:

Position Purpose: The Member Enrollment Lead partners with Health Plan and ACO leaders, as well as cross-functional business partners, to develop, implement, and monitor operational processes for all member enrollment functions.


The Member Enrollment Lead is a subject matter expert on the business and regulatory requirements for member enrollment and tracks performance against these requirements. S/he works closely with the Government Programs business unit and Information Services to manage the end-to-end enrollment process, including intake, validation, vendor/system interface, and reporting. The Member Enrollment Lead reports enrollment-related performance statistics to executive and product-line leadership on a regularly recurring basis. This position also works closely with product leadership to resolve issues with member enrollment.


Enrollment processing & validation:

* Oversee and monitor enrollment file (e.g., 834) processing by IS team

* Facilitate prioritization of IS-related development and processing as new requirements are identified by payer and/or business

* Identifies opportunities to improve efficiency and effectiveness by working with relevant stakeholders to automate enrollment processing, discrepancy identification and reconciliation

* Maintain an accurate and current account of enrollment to serve as single source of truth for the plan


Vendor interface & management:

* Oversee and monitor all member roster extracts delivered to vendors on routine or ad hoc basis

* Institute processes and controls to ensure accurate, complete, consistent, and timely data feeds to downstream systems and vendors

* Identify and reconcile data errors and escalate systemic issues to Government Programs business unit, IS, and compliance, as necessary


Finance, risk adjustment & performance:

* Monitor accuracy of monthly premium payments from payer(s) by reconciling enrollment and premium revenue, including reconciling discrepancies with payer(s)

* Collaborate with Government Programs business unit and Finance to support budget and staffing projections where FTE allocations are a function of enrollment

* Monitor throughput on rate cell changes triggered by performance programs

* Verify member enrollment for measurement of ACO cost performance


Analytics & reporting:

* Track enrollment trend via weekly and monthly dashboards that serves as source of truth for membership

* Identify discrepancies (e.g., multiple IDs, members living out of service area) in enrollment data and reconcile with payer(s)

* Manage generation of monthly member rosters for ACO participating practices


Demonstrate leadership behavior in individual performance by contributing to effective management within Call Center Operations. Set example of proper behavior and accountability to employees.


Leads the charge in focus and implementation of the organization's culture and strategic plan in a way that aligns to the mission, vision and values of the organization.


Education / Experience / Other Requirements:


Education:

* Bachelors degree in business, health care, or related field required

* Masters degree in business administration, public policy, public health, or related field preferred


Work Related Experience:

* At least five (5) years operations management experience and/or health care related field

* At least two (2) years management experience

* Operations management-related activities in a health plan setting, preferred

* Medicaid managed care experience preferred


Specialized Knowledge:

* Requires excellent writing skills.

* Requires demonstrated competence in project management with strong conceptual, communications, design and organizational skills.

* Complete tasks with little supervision

* Ability to lead others

* Ability to think analytically and make independent decisions

* Ability to manage multiple projects and prioritize work tasks to adhere to deadlines and identified time frames





Application Instructions

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