What are the responsibilities and job description for the Enrollment Manager position at Solis Health Plans?

Job Description

About us :

Solis Health Plans is a new kind of Medicare Advantage Company. We provide solutions that are more transparent, connected, and effective for both our members and providers. Solis was founded with a desire to provide a more personalized experience throughout all levels of the healthcare journey. Our team consists of expert individuals that take pride in delivering quality service. We believe in a culture that collaborates and supports one another, and where success is interlinked, and each employee is valued. Please check out our company website at www.solishealthplans.com to learn more about us!

POSITION IS ONSITE Mon-Friday, Bilingual in Spanish is required.

Full benefits package offered on the first of the month following date of hire including : Medical, Dental, Vision, 401K with a 100% company match! Our company has double in size and we have experienced exponential growth in membership from 2,000 members to over 10,000 members.

Join our winning Solis Team!

Position Summary :

Responsible for providing guidance and setting policies for the accurate and timely processing of enrollment and disenrollment forms in accordance with Medicare Guidelines, State and Federal Law as well as company policies.

Essential Duties and Responsibilities :

Oversees the processing of enrollment and disenrollment elections from Medicare beneficiaries, as well as any other required update to a member record.
Performs monthly membership audits.
Monitors FDR eligibility error reports for correction.
Transmits election information to CMS within specified timeframes and according to CMS regulations.
Establishes utilization reports to optimize enrollment data.
Ensures appropriate letters are sent to members within CMS timeframes.
Analyzes system efficiency and determines adjustments and enhancements as needed.
Handles all Medicare retroactive processing contractor requests.
Trains the department staff members and provides them with methods and techniques to perform their job efficiently.
Assists the department staff members with discrepancies and dispute resolutions.
Works together with Marketing, Compliance, Claims, Member Services, and Finance departments to enhance member profiles.
Handles enrollment data validation for CMS and complies with regulatory reporting standards
Audits data entered into the plans internal systems to ensure data integrity and quality.
Uses judgment and informed decision-making to determine appropriate actions on elections and in handling discrepancies.
Meets with Senior VP of Operations and Business Intelligence on a regular basis to :

Provide feedback on departmental and staff issues / opportunities.

Staffing requirements and needs.

Receive feedback on own performance.

Reviews overtime report and ensures communication with staff as appropriate.

Ensure compliance with state and federal laws.

Supervises the department staff members, provides guidance, and evaluates performance as needed.

Performs all other duties as assigned.

Supervisory Responsibility :

Qualifications and Education :

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and / or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Graduate of an accredited college or university with at least a Bachelor’s degree in Business Administration, Public Health Administration or related field and four (4) years’ experience working with CMS regulations; or equivalent combination of education and experience.

Minimum of 2 years’ experience in a demonstrated leadership and management role required.

Familiarity with healthcare laws, regulations, and standards.

Working knowledge of the Privacy and Security Health Insurance Portability and Accountability Act (HIPAA) regulations.

Working knowledge of Medicare and Medicaid enrollment and eligibility requirements and processes

Excellent customer service skills.

Excellent listening, interpersonal, verbal and written communication skills with individuals at all levels of the organization.

Excellent computer knowledge is required, including proficient knowledge of Microsoft Office.

Ability to create reports from different data pools and present findings efficiently.

Must be self-motivated, organized and have excellent prioritization skills.

Must be patient in dealing with an elderly population and sympathetic to hearing or vision deficiencies.

Ability to work effectively independently and in a team environment.

Ability to read, analyze, and interpret technical procedures or governmental regulations.

Ability to write reports, business correspondence, and procedure manuals.

Ability to effectively present information and respond to questions from groups of managers, clients, customers and the general public.

Ability to calculate figures and amounts, such as discounts, interest, commissions, proportions, percentages, area and volume.

Ability to define problems, collect data, establish facts, and draw valid conclusions.

Strong decision-making, analytical skills.

Must be able to work well under stressful conditions.

Must be able to work in a fast-paced environment.

Fluency in Spanish and English required.

What Sets Us Apart :

Join Solis Health Plans as an Enrollment Manager and become a catalyst for positive change in the lives of our members. At Solis, you will be part of a locally rooted organization deeply committed to understanding and serving our communities. If you are eager to embark on a purpose-driven career that promises growth and the chance to make a significant impact, we encourage you to explore the opportunities available at Solis Health Plans. Join us and be the difference!

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