Enrollment and Reconciliation Manager (2-month contract)

Description

Are you ready to make a lasting impact and transform the healthcare space? We are one of Southern California’s fastest-growing Medicare Advantage plans with an incredible 112% year-over-year membership growth.  

Who Are We? ✨ 

Clever Care was created to meet the unique needs of the diverse communities we serve. Our innovative benefit plans combine Western medicine with holistic Eastern practices, offering benefits that align with our members’ culture and values. 

Why Join Us? 🏆

We’re on a mission! Our rapid growth reflects our commitment to making healthcare accessible for underserved communities. At Clever Care, you’ll have the opportunity to make a real difference, shape the future of healthcare, and be part of a fast-moving, game-changing organization that celebrates diversity and innovation. 

Functions & Job Responsibilities

• Established department priorities and strategies to facilitate meeting Enrollment and Reconciliation Department goals including the identification of budgetary resource requirements, staffing projections and other operating resources.
• Assists the Department with building team member subject-matter expertise in the array of available data; understands opportunities and limitations of various data sets; Mentors, trains and develop staff; Partners with internal teams to understand reporting needs and visualization tools.
• Collaborates with various departments to identify and resolve complex issues and errors that involve internal and external systems, government data, and regulatory guidance; leads and executes complex data-related analytical projects to drive business decisions and efficiencies; ensures timely and accurate reporting, correction of issues and errors, implements best practices. May support audits and attestations.
• Oversees audits and reconciliation activities to ensure regulatory compliance, applies audit findings to improve departmental efficiency and maintain the integrity of the enrollment files.
• Maintains up to date knowledge of regulatory requirements and industry best practices as it relates to data. Attends CMS training sessions and other appropriate industry meetings.
• Maintains oversight of department performance and established team priorities and goals to achieve strategic goals.
• Work with cross-functional departments by providing support to brokers, IPA/PCPs as necessary; with an emphasis on front-line eligibility, application processing, reporting and other data exchange problem-solving.
• Other duties as assigned.

Qualifications

Qualifications

Education & Experience:

• Bachelor’s degree or equivalent combination of education and experience.
• Minimum two (2) years Enrollment & Reconciliation supervisory experience.
• Minimum four (4) years of Medicare Enrollment experience at the health plan level.
• Must be familiar with Medicare Advantage audit, compliance and reporting requirements

Skills:

• Knowledge related to enrollment & eligibility, ID cards, PCP Assignment, Member Materials.
• Knowledge of CMS regulations, reporting requirement and member material requirements Familiar with CMS enrollment processes, MARx system, and CMS Plan Communication User Guide files and transactions.
• Highly efficient in preparing documents, managing data and ability to manage multiple projects simultaneously
• Strong work ethic to meet changes in responsibilities that will take place daily.
• Capacity to work independently and as team player
• Must have excellent verbal and written communication skills.
• Strong leadership and mentoring qualities.
• Experience working with EZ-CAP is a plus

Wage Range: $45.00/hr - $55.00/hr

Physical & Working Environment.

Typical Physical Demands.
Position requires a great amount of driving, sitting and standing. Some standing, stooping, bending or reaching is required. May require lifting up to 15 pounds. Requires manual dexterity sufficient to operate a computer, calculator and telephone. Requires normal range of hearing and vision. Requires the ability to type and file.

Typical Working Conditions.
Work is performed in an office environment and/or remotely. The job involves frequent contact with staff and public. Work may be stressful at times. May occasionally work some irregular hours.

Clever Care Health Plan is proud to be an Equal Employment Opportunity and Affirmative Action workplace. Individuals seeking employment will receive consideration for employment without regard to race, color, national origin, religion, age, sex (including pregnancy, childbirth or related medical conditions), sexual orientation, gender perception or identity, age, marital status, disability, protected veteran status or any other status protected by law. A background check is required.

Salary ranges posted on the job posting are based on California wages. Salary may be higher or lower depending on the candidate’s state residency.

Salary : $45 - $55