Virginia Premier Health Plan, Inc.

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Senior Director, Enrollment

Senior Director, Enrollment

Job Locations 
US-VA-Glen Allen
Job ID 
2017-4297

Job Description

Overview

The Senior Director, Enrollment is responsible for operational outcomes of the Virginia Premier enrollment teams for all lines of business, including all Medicaid lines of business (e.g. Medallion and MLTSS) and Medicare lines of business (e.g. MAPD, DSNP).  Incumbent will act as subject matter expert for the Enrollment functions of the Member Operations Department. The incumbent will facilitate the development of enrollment operations on new lines of business and will ensure successful implementations.

 

Responsibilities

  • Set strategic direction for Enrollment business strategy and operational process improvements.
  • Have a holistic view of the organization and ensure that Enrollment works collaboratively with all departments towards optimal corporate outcomes.
  • Lead and oversee the teams that ensure the transmission and data validation of all enrollment related files.
  • Lead and oversee the processes that ensure external vendors receive and load enrollment files in accordance with business timelines and requirements, inclusive of validation processes.
  • Demonstrate comprehensive understanding of DMAS and CMS Enrollment contractual requirements and ensure that knowledge is disseminated to all enrollment team members.
  • Ensure compliance with all contractual requirements related to members receiving enrollment related member materials.
  • Manage internal systems and measures to enhance effective, efficient, and compliant operations. Ensure that the health plan’s enrollment processes are executed in an efficient manner utilizing robust tools and technology.
  • Identify and monitor performance metrics; ensure the timely and accurate monitoring and reporting of performance against metrics. Identify critical issues and trends and address performance issues and concerns.  Manage various management reporting activities, including regulatory reporting and corporate management reporting. 
  • Lead all Enrollment system changes, upgrades and implementations to include preparation of Business Needs and Requirements documents, as well as test scripts and successful end to end and regression testing upon completion.
  • Lead management of future expansions into new business areas.
  • Provide oversight in the review, revision and submittal of all Policies and Procedures (P&Ps) as related to Enrollment.
  • Perform other managerial duties as required.

 

Qualifications

MINIMUM EDUCATION REQUIREMENTS

  • Bachelor’s degree in Health Services, Business Administration or related field.

 SPECIAL KNOWLEDGE AND/OR SKILLS

  • Proven ability to work independently while managing multiple tasks and deadlines
  • Experience in use of information system resources
  • Candidate will be proficient with data analysis or business analysis in a health care environment.
  • Understanding of Medicaid and Medicare healthcare insurance markets, the HMO concept and business operati
  • Computer literacy including demonstrated proficiency in all Microsoft Office products.
  • Ability to review data and identify trends.
  • Excellent oral & written communication skills plus strong organizational skills.
  • Demonstrated leadership experience.
  • Ability to plan, prioritize and manage multiple projects while meeting deadlines and achieving business goals.
  • Comprehensive understanding of Department of Medical Assistance Services (DMAS) and Centers for Medicare and Medicaid (CMS) contract requirements preferred.
  • Ability to supervise staff and promote successful performance.
  • Strong problem solving skills in a fast paced environment.

 WORK BACKGROUND/EXPERIENCE

  • Five (5) years managerial level experience.
  • Knowledge of Six Sigma desired.
  • Experience in managed care or health insurance operations.

PHYSICAL REQUIREMENTS

  • Physical health sufficient to meet the ergonomic standards and demands of the position.

About Us

Virginia Premier Health Plan, Inc. is a managed care organization which began as a full-service Medicaid MCO in 1995. Partnered with VCU Medical Systems we strive to meet the needs of the underserved and vulnerable populations in Virginia by delivering quality driven, culturally sensitive and financially viable Medicare and Medicaid healthcare programs.  Headquartered in Richmond, VA we also have offices in Roanoke, Tidewater and Bristol with additional satellite locations allowing us to serve over 200,000 members across eighty counties throughout Virginia. 

 

We offer competitive salaries and a comprehensive benefits package to include excellent Medical, Dental and Vision Plans, Tuition Assistance, Infant-At-Work Program, Remote Work options and generous vacation and sick leave policies. Our culture supports an environment where employees can continuously learn and gain professional growth through various development programs, education, exciting projects and career mobility.  

 

All qualified applicants will receive consideration for employment without regard to age, race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or protected veteran status. EOE

 

Our mission is to inspire healthy living within the communities we serve!

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