Resp & Qualifications
Enrollment Manager is responsible for investigation and resolution of complex enrollment issues, in accordance to CareFirst CHPDC’s District contract guidelines. This role ensures that these issues are resolved within the mandatory guidelines as established by state and federal regulatory agencies and in accordance with CareFirst CHPDC policy.
ESSENTIAL DUTIES AND RESPONSIBILITIES
- Manage enrollment team and oversee all enrollment-related functions.
- Facilitate and/or assist with the automated enrollment process for assigned market(s), including automated monthly loads, member reconciliation, member notifications, including newborn enrollments and preemie dis-enrollments for DC.
- Review and reconcile daily, weekly fallout/exceptions reports.
- Perform and/or assist with the mass PCP changes, Provider Terminations, and maximum Provider Panel Closings.
- Submit accurate and timely regulatory reporting, participate in regulatory audits. Ability to utilize strong analytics skills and provide high level reporting to leadership.
- Validate and update District TPL/COB in MHC and prepare reports.
- Perform regular vendor enrollment reconciliation and troubleshoot vendor enrollment issues.
- Ensure all team documentation that goes to DHCF is accurate, complete and timely, inclusive of all paperwork associated with newborns and disenrollments.
- Create and maintain policies and procedures and SOPs to ensure compliance with District contract.
- Oversee the enrollment claims queue ensuring timely working of all claims.
- A minimum of 5 years of membership enrollment experience
- A minimum of 2 years of management experience
- Experience working with health care benefits or DC Medicaid
- Principles and practices of the managed health care systems, and medical administration and NCQA Accreditation standards.
- Exercise exceptional judgment in decision-making, meet deadlines, and to work independently and with flexibility
- Managed Care experience preferred
- Problem solving skills
- MHC preferred
- Proficient in Microsoft Office tools (Excel, PowerPoint)
Equal Employment Opportunity
CareFirst BlueCross BlueShield is an Equal Opportunity (EEO) employer. It is the policy of the Company to provide equal employment opportunities to all qualified applicants without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, protected veteran or disabled status, or genetic information.
Hire Range Disclaimer
Actual salary will be based on relevant job experience and work history.
Where To Apply
Please visit our website to apply: www.carefirst.com/careers
Please apply before: 11/13/2020
Federal Disc/Physical Demand
Note: The incumbent is required to immediately disclose any debarment, exclusion, or other event that makes him/her ineligible to perform work directly or indirectly on Federal health care programs.
The associate is primarily seated while performing the duties of the position. Occasional walking or standing is required. The hands are regularly used to write, type, key and handle or feel small controls and objects. The associate must frequently talk and hear. Weights up to 25 pounds are occasionally lifted.
Sponsorship in US
Must be eligible to work in the U.S. without Sponsorship