Director Enrollment Billing

Director of Enrollment, Billing and Reconciliation

The Director of Enrollment, Billing and Reconciliation oversees overall enrollment, eligibility, and billing operations and all associated reconciliation functions across all products. The Director leads Enrollment, Billing & Reconciliation operations teams to ensure timely and accurate processing of eligibility, enrollment, and billing transactions and processes. The incumbent ensures the highest level of service is provided to members, customers, and internal stakeholders while promoting member satisfaction and account retention. High level of engagement and collaboration with Market General Managers and internal stakeholder Executives is required. Additionally, the incumbent ensures regulatory compliance with all Centers for Medicare & Medicaid Services (CMS) Guidelines and Department of Health regulations as well as all associated offices. The Director remains flexible while utilizing strategic thinking and creativity to address challenges in alignment with long-term growth and profitability goals.

Key Accountabilities :

• Enrollment, Billing and Reconciliation Operations
• Understands and aligns with Medicas strategic vision and priorities.
• Collaborates with all levels of the leadership team, peers, and business partners.
• Develops / designs enrollment, billing, and reconciliation operations processes that align to the member and customer experience to ensure that service is the top priority.
• Proactively monitors operational performance.
• Initiates and drives appropriate change in processes, tools, and capabilities that increase operational efficiency and effectiveness while concurrently improving the member / customer experience and complying with regulatory requirements.
• Achieves key performance metrics, including member satisfaction, quality, compliance, employee engagement, and financial objectives.
• Identifies and resolves operational, organizational, and business problems that affect the Enrollment and Billing organization, including management of dependencies upstream and downstream and coordination with Technology Partners.
• Leverages Six Sigma and Lean methodology to support continuous improvements and oversight of the Enroll Value Stream with an enterprise mindset.
• Directs overall enrollment, billing, and reconciliation operations, determines performance objectives / metrics, cost center budget, and defines tools to measure progress, ensuring consistent achievement of business objectives.
• Presents timely, accurate, and complete business plans, reports, and presentations.
• Workforce Management
• Maintains and supports on-going workforce management processes and controls, focusing on quality.

Equal Opportunity Employer including Veterans and Disabled Individuals