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HealthAxis Group, a leader in healthcare technology, is looking for a Healthcare Enrollment Manager to join our team. The Healthcare Enrollment Manager (HEM) is responsible for overseeing the Medicare Advantage-PD Enrollment department staff and daily operations, ensuring CMS, HIPAA and overall compliance performance, and coordinating resources to ensure operational excellence. Responsible for developing plans to ensure compliant workflows, SOP’s and policy and procedures.

 

Principal Duties and Responsibilities:

 

  • Improve the efficiency and quality in delivering healthcare enrollment services – improve processes by evaluating existing workflows, coordinating cross functional processes, and implementing /monitoring of enrollment processing environment.
  • Develop departmental goals and objectives and meet or exceed organizational operational goals.
  • Recruit, train, and supervise assigned team members – including conduct interviews, select staff, and train employees; provide on-going mentoring of employees and foster an atmosphere of teamwork; establish employee performance goals and monitors progress towards achievement of those goals; create work schedules and direct the work of team employees; evaluate employees’ performance and productivity; take disciplinary actions with employees as needed; address employee complaints and grievances; make decisions or effective recommendations regarding the hiring, firing, promotion and other status changes, and regarding pay rates of employees.
  • Accountable for the day to day Healthcare Enrollment Operations, including maintenance and security. Responsible for the reconciliation of eligibility and enrollment data, and ensure that databases and systems are complete, accurate, and accessible only to authorized personnel.
  • Responsible for overall compliance of Enrollment – stay up to date with evolving information technology, current or proposed HIPAA (Health Insurance Portability and Accountability Act) and CMS (Centers for Medicare and Medicaid Services) laws and regulations, and trends in managing large amounts of complex data.
  • Coordinate the collection, reporting and analysis of MA, MAPD, POS, PPO plan data per CMS guidance.
  • Develop new processes for newly effective CMS requirements or changes to existing enrollment policies.
  • 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.
  • Utilize internal departmental and corporate data management resources to their fullest
  • Serve as responsible party for issues related to Enrollment department’s performance and company impact.
  • Assist with the preparation and monitoring of costs and budgets.
  • Foster positive collaboration across interdependent departments.
  • Communicate effectively with upper management and prepare reports regarding goals, progress, efficiency issues and cost-saving solutions.

 

Qualification:

 

  • Bachelor’s degree in health management/administration, business administration/management with health specialization, or closely related field (or the equivalent). Master’s/MBA degree a plus.
  • 5 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 complex software programs.
  • Ability to formulate and articulate persuasive dialogue.
  • Ability to understand and convey complex financial information.
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