• Manager, Medicaid Enrollment

    Job Locations US-VA-Glen Allen
    Job ID
    2018-5080
  • About Us

    Don’t just find a job, find your WHY at a purpose-driven organization; discover a career at Virginia Premier.
    By blending quality benefits, affiliating with the world-renowned VCU Health System and offering career-advancing development programs, we allow our employees to focus on the meaningful work of improving and saving the lives of more than 200,000 people throughout the state of Virginia.
     
    At Virginia Premier, we are building an industry leading health care organization through dedicated teams that have heart, provide top-notch quality member services and embrace our mission of inspiring healthy living within the communities we serve. Our vision is to connect people to innovation, quality and affordable health care for all phases of life.
     
    If this sounds like you, read on!

    Overview

    The Manager, Medicaid Enrollment is primarily responsible for oversight of daily operations, all applications and systems associated with Medicaid Enrollment. Incumbent will ensure Enrollment Analysts and Member Operations Representatives (MORs) are in compliance with all company and departmental policies, procedures and standard operating procedures. Incumbent will provide direct oversight and implementation of all changes to Medicaid Enrollment in the Member Operations Department. These efforts may include but are not limited to; 834, 820, enrollment mailings, eligibility files and DMAS audits. Responsible for supporting and contributing to cross functional and or Six Sigma corporate projects.

    Responsibilities

    • Provide direct supervision of Enrollment Analysts and MOR agents
    • Responsible for completion and submission of enrollment monthly, quarterly and annual departmental reports to regulatory agency
    • Responsible for submitting and obtaining approval from regulatory agency for various member materials
    • Provide support for enrollment applications which includes customizing, upgrading, integrating and troubleshooting, and testing applications software
    • Direct, oversee requests, and ensure proper testing of enrollment system and vendor file changes. Serve as liaison with IT department to implement and test changes to enrollment applications
    • Provide training, development, and motivation of MORs and Enrollment Analysts to carry out their assigned job functions
    • Manage, review, revise and submit all Policies and Procedures (P&Ps) as related to Member Operations
    • Ensure the proper loading and data validation of all enrollment related files to include, but not limited to 834, 820 payment files, and eligibility files.
    • Demonstrate comprehensive understanding of DMAS contractual requirements
    • Ensure that enrollment related member materials are mailed in the timeframes outlined by DMAS
    • Develop and oversee accurate operational metrics for the department analyzing and identifying trends for operational improvements
    • Prepare detailed flowcharts, diagrams and training materials for all applications used by Enrollment operations
    • Execute directives issued by Virginia Premier Health Plan, Inc. and those issued by the Director, AVP and VP of Member Operations
    • Develop, analyze and distribute enrollment reports to Director, AVP and VP of Member Operations
    • Create and maintain system and process documentation
    • Develop and design reports for utilization, financial costs, and other reports as they become necessary or apparent
    • Oversee and manage enrollment related projects
    • Other duties as they become apparent and/or necessary

    Qualifications

    MINIMUM EDUCATION REQUIREMENTS

    • Bachelor’s Degree in Business Administration, Mathematics, Data Analytics, Information Systems/Technology, or a related business field.

    SPECIAL KNOWLEDGE AND/OR SKILLS

    • Understanding of Medicaid healthcare insurance markets, the HMO concept and business operations
    • Understanding of health care enrollment strongly desired
    • Ability to review data and identify trends
    • Experience with data analysis software such as: Excel, Access, and SQL
    • Experience with Managed Care reporting
    • Excellent oral & written communication skills plus strong organizational skills
    • Demonstrated leadership skills
    • Ability to plan, prioritize and manage multiple projects while meeting deadlines and achieving business goals
    • Ability to analyze data from disparate systems
    • Demonstrate comprehensive understanding of Department of Medical Assistance Services (DMAS) contract requirements
    • Ability to supervise staff and promote successful performance
    • Strong problem solving skills in a fast paced environment
    • Strong facilitation, design and development skills

    WORK BACKGROUND/EXPERIENCE

    • Previous management experience a plus
    • Knowledge of Six Sigma desired
    • Experience in training or department development including instructional design and delivery
    • Prior quality (e.g. accreditation and/or regulatory) experience, especially related to ensuring compliance with state, federal and accreditation regulations and/or standards is preferred

    PHYSICAL REQUIREMENTS

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

    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.

     

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

     

     

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