Enrollment Manager

Job Description

Job Description

Apply on line at http : / / www.alohacare.org / Careers / Default.aspx

The Company :

AlohaCare is a local, non-profit health plan serving the Medicaid and Medicare dual eligible population. We provide comprehensive managed care to qualifying health plan members through well-established partnerships with quality health care providers and community-governed health centers. Our mission is to serve individuals and communities in the true spirit of aloha by ensuring and advocating access to quality health care for all. This is accomplished with emphasis on prevention and primary care through community health centers that founded us and continue to guide us as well as with others that share our commitment. As Hawaii’s third-largest health plan, AlohaCare offers comprehensive prevention, primary and specialty care coverage in order to successfully build a healthy Hawaii .

The Culture :

AlohaCare employees share a passion for helping Hawaii’s most underserved communities. This passion for helping and caring for others is internalized and applied to our employees through a supportive and positive work environment, healthy work / life balance, continuous communication and a generous benefits package.

AlohaCare’s leadership empowers and engages its employees through frequent diversity, recognition, community, and educational events and programs. AlohaCare has a strong commitment to support Hawaii’s families and reinforces a healthy work / home balance for its employees. Because AlohaCare values honesty, respect and trust with both our internal and external customers, we encourage open-door, two-way communication through daily interactions, employee events and quarterly all-staff meetings. AlohaCare’s comprehensive benefits package includes low-cost medical, dental, drug and vision insurance, PTO program, 401k employer contribution, referral bonus and pretax transportation and parking program.

These employee-focused efforts contribute to a friendly, team-oriented culture which is positively reflected into the communities we serve.

The Opportunity :

The Enrollment Manager is responsible for the operations of the AlohaCare Enrollment Department which includes enrollment / disenrollment processing, maintenance of enrollment information and demographic changes (including coordination of benefit, Medicare Secondary Payer and Medicare Late Enrollment Penalty information), communicating with appropriate external organizations for all lines of business (including all post-application activities for Medicare, QUEST newborn follow-up and disability disenrollment tracking), TPL follow-up for all lines of business, QUEST 1179 submissions and follow-up, PDE enrollment corrections, plan transfers, 4Rx enrollments, LIS rate code maintenance / matching, maintaining enrollment segment accuracy between PBM system and QNXT. The Enrollment Manager is responsible for training and supervising the Enrollment Department staff and monitoring all key processes and performance indicators to ensure compliance with contractual, regulatory, and AlohaCare requirements.

Primary Duties and Responsibilities :

• Accountable for the proper administration of the Enrollment Department functions within AlohaCare which includes the detailed monitoring of Medicare and QUEST enrollment transactions and processes.
• Accountable for the integrity of enrollment data and accuracy of transmission to multiple systems (such as QNXT, Carelon, 4Rx, CMS and any enrollment intermediary).
• Responsible for process improvement within the Enrollment Department and working with other departments to improve interdepartmental processes impacting Enrollment Department workflows and productivity.
• Responsible for working with Information Systems staff to automate enrollment processes and interfaces to improve the accuracy and efficiency of department operations. Includes processes for handling plan enrollment and disenrollment transactions, tracking / monitoring of Medicare ESRD members, generation of member notices, and development of monitoring reports.
• Develop / oversee department performance standards, goals, priorities and budgets including the monthly reporting of variances to standards and budgets.
• Supervision of Enrollment Department staff including ensuring the compliance with all CMS beneficiary communication requirements.
• Establish and monitor production schedules consistent with CMS / QUEST timelines.
• Manage relationship with any outside enrollment processing vendors, identifies and works to resolve any system processing issues.
• Primary contact with enrollment sponsors (State Medicaid and CMS agencies) for information transfer and issue resolution.
• Develop automated work process for plan rejections, CMS rejections, auto disenrollments, enrollments to incorporate audit reports and adherence to required notifications and timelines.
• Responsible for apprising other departments of internal and external enrollment-related issues that may impact the organization and takes appropriate action to incorporate changes into day-to-day operations.
• Responsible for apprising Senior Director of Plan Operations of the status of major activities and significant operational issues.
• Responsible for staff training and development, maintenance of applicable AlohaCare Enrollment Policies and Procedures, and maintenance of comprehensive Enrollment Department manuals and workflows.
• Participate in organizational meetings, workgroups or assigning other departmental staff to participate, as appropriate
• Participates in corporate operational strategic planning and problem solving.
• Filling position vacancies / supervising

Interviewing potential new hires, along with the department Lead

Being aware and knowledgeable of key requirements (contractual, regulatory, accreditation) related to departmental and pertinent interdepartmental activities, and the reference materials supporting these

Ensure smooth execution of key interdependencies (organizationally and departmental)

Required Qualifications :

Preferred Qualifications :

Mental, Physical and Environmental Demands :

AlohaCare is committed to providing equal employment opportunity to all applicants in accordance with sound practices and federal and state laws. Our policy prohibits discrimination and harassment because of race, color, religion, sex (including gender identity or expression), pregnancy, age, national origin, ancestry, marital status, arrest and court record, disability, genetic information, sexual orientation, domestic or sexual violence victim status, credit history, citizenship status, military / veterans’ status, or other characteristics protected under applicable state and federal laws, regulations, and / or executive orders.