Director of Health Plan Enrollment Operations
Location: Temple, Texas US
Requisition Number: 19014042
Reporting to the Chief Financial Officer, the Director of Health Plan Enrollment Operations directs functions of Commercial Fully-Insured Self-Insured, Medicaid and Medicare enrollment at the Scott & White Health Plan (SWHP). This includes appropriate oversight, quality assurance audits, timely and accurate membership enrollment and ID card production and distribution.
- Directs enrollment team to ensure that SWHP members and employers receive timely and accurate information, have requested plan changes recorded accurately, and receive prompt responses to inquiries
- Directs hiring, training, evaluations and disciplining of employees when necessary.
- Responsible for department budget. Seeks avenues of cost containment and plans long-term purchases of capital equipment.
- Monitors and ensures processes and policies are documented and communicated.
- Monitors that members are provided with accurate ID cards and appropriate certifications of coverages and other notifications on a timely basis and/or within regulatory or contracted timeframes.
- Ensures adequate staffing levels utilizing staffing models and ensures appropriate separation of duties.
- Establishes and implements quality assurance programs to ensure that accurate and efficient services are being provided to members, employers, and providers.
- Directs departmental training, and re-training when necessary, to maintain knowledgeable staff members and the highest level of service delivery.
- Monitors results of routine quality assurance audits.
- Provides member eligibility and primary care physician data to ensure accurate information
- Monitors timely and accurate input of employer group and individual plan information into the enrollment platform to ensure correct billing and claims payment.
- Monitors timely and accurate input of member eligibility data into the enrollment platform. Ensures all applicable eligibility guidelines are followed for eligibility updates.
- Maintains Employer Portal in order for employer groups to access current eligibility data, benefits and monthly invoices.
- Responsible for Enrollment implementation of new products.
- Ensures compliance with regulatory agencies guidelines for enrollment activities (CMS, HHSC, TDI)
- Responsible for providing accurate and timely membership reports.
- Ensures accurate member interfaces are developed and maintained with Scott & White, Pharmacy PBM, etc., and reconciles these external interfaces as needed.
- Monitors communications between collections staff and member or employer to ensure professionalism and customer satisfaction.
- Knowledge of and working experience in industry enrollment platforms, Excel, Access, Crystal Repots and database reporting required.
Community / Marketing Title: Director of Health Plan Enrollment Operations
Location_formattedLocationLong: Temple, Texas US
CountryEEOText_Description: We are an equal opportunity employer committed to ensuring a diverse workforce. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability status, protected veteran status, or any other characteristic protected by law. To view the most recent EEO is the Law Poster, click here.