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Health Axis Group, a leader in healthcare technology, is looking for an Enrollment Operations Manager to join our team. The Enrollment Operations Manager (EOM) is responsible for overseeing the effective operations of the Medicare Advantage PD Enrollment team and its staff. The EOM identifies and solves issues, collects and analyzes data to develop plans to ensure compliant operationalization workflows and to develop effective SOP’s and policies, coordinates resources to ensure operational excellence, ensures CMS, HIPAA and overall compliance, and oversees day to day operations.

 

Principal Duties and Responsibilities:

  • Collect and organize information from a variety of sources, such as internal departmental and corporate data management resources, internal databases, sales histories, employee feedback, and customer feedback, to identify and resolve issues.
  • Use statistical analysis, simulations, predictive modeling, and other methods to analyze information and develop practical solutions.
  • Coordinate the collection, reporting and analysis of MA, MAPD, POS, PPO plan data per US DHHS Centers for Medicare & Medicaid Services (CMS) guidance, and responsible for the HIPAA, CMS, and overall compliance of the Enrollment team.
  • Develop new processes for newly effective CMS requirements or changes to existing enrollment policies and reconcile the eligibility data and the enrollment data.
  • Prepare reports and other documents to explain findings and make recommendations to address issues or make improvement to upper management.
  • In coordination with VP, accountable for CMS monitoring visits, including visit preparation, mock visits and actual visits, responses on issues with respect to enrollment; ensures recommended changes are implemented.
  • Improves processes by evaluating existing workflows, coordinating cross functional processes and implementing/monitoring of enrollment processing environment.
  • Supervise the assigned team/staff – including providing coaching, mentoring, and development of employees and ensuring proper training received; fostering an atmosphere of teamwork; establishing performance goals with employees and monitoring progress with regard to achievement of those goals; and evaluating employees’ performance and productivity;
  • Foster positive collaborations across interdependent departments.

 

Qualification:

  • Bachelor’s degree in Business Administration  or closely related field (or the equivalent); and
  • 5 years of relevant experience, plus knowledge of the healthcare industry required;
  • Or a Master’s degree in Business Administration (MBA) or closely related field, and 2 years of relevant experience, plus knowledge of the healthcare industry required;
  • Excellent oral and written communication skills, including good grammar, voice and diction.
  • Excellent analytical and problem-solving skills.
  • Proficient in MS Office.
  • Ability to navigate and master software programs.
  • Ability to formulate and articulate persuasive dialogue and to understand and convey complex financial information.
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