Manager of Enrollment Medicare

Job Details Job Location Smithfield, RI - Smithfield, RI Position Type Full Time Education Level Bachelors Degree   Travel Percentage Occasional Job Shift Daytime Job Category Management Description

The Manager of Enrollment Medicare is responsible for managing enrollment activities for Medicare-Medicaid (MMP) and D-SNP lines of business. This position is accountable for the accurate, timely processing and data entry of Medicare enrollments, re-enrollments and disenrollment, subsequent maintenance of the enrollment data, compliance with regulatory requirements relating to enrollments and disenrollment, filing of applications, and other related documents. This position works with internal and external stakeholders to address broad, complex enrollment issues. The position also maintains high visibility and accountability to both state and federal entities including the Executive Office of Health and Human Services (EOHHS), Department of Health (DOH), and Centers for Medicare and Medicaid Services (CMS).

Duties and Responsibilities

Responsibilities include, but are not limited to, the following :

• Preparation and timely processing of enrollment transactions, management, and maintenance in accordance with CMS regulations.
• Ensures compliance with all applicable policies and procedures.
• Maintenance of strong knowledge of the Enrollment process along with State, Federal, and business regulatory requirements and other state specific applications concerning Managed Care Enrollment
• Engage in on-going performance management of staff including coaching, mentoring, development, training and succession planning to include hiring and termination decisions
• Ensure quality control of data entered into membership data base, as well as timely and accurate dissemination of eligibility data to internal systems and external vendors and delegated entities.
• Serves as the subject matter expert and lead on functional deliverables ensuring optimal efficiency of member enrollment
• Oversees and participates in state, federal, and internal audits, as needed.
• Ensure diligent record keeping and audit trails for all relevant inbound and outbound files
• Establish and keep current all departmental policies and procedures
• Responsible for ensuring timely reconciliation of eligibility files and adjustments to CMS that meet regulatory and health plan requirements, as required.
• Coordinate and manage the generation and mailing of all necessary correspondence relating to enrollment, re-enrollment, and disenrollment in accordance with CMS time frames.
• Partners with vendor management team and the external vendor to ensure service level agreements and regulatory requirements are met.
• Responsible for communicating and following up on files delayed by CMS and / or State or issues with a file that require Health Plan involvement.
• Responsible for ensuring timely reconciliation of eligibility files and adjustments to CMS that meet regulatory and health plan requirements.
• Partners with vendor management team and the external vendor to ensure service level agreements and regulatory requirements are met.
• Other duties as assigned
• Corporate Compliance Responsibility - As an essential function, responsible for complying with Neighborhood's Corporate Compliance Program, Standards of Business Conduct, applicable contracts, laws, rules and regulations, policies and procedures as it applies to individual job duties, the department, and the Company. This position must exercise due diligence to prevent, detect and report unlawful and / or unethical conduct by fellow co-workers, professional affiliates and / or agents.

Qualifications

Qualifications

Required :

Preferred :

Neighborhood Health Plan of Rhode Island is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability or veteran status.