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Director Billing & Enrollment - Health Plan

Company: Health First
Location: Melbourne
Posted on: April 13, 2019

Job Description:

Description:The Health First Health Plan (HFHP) Enrollment and Billing Director provides principle leadership for and accountability of all components of the Health Plans ability to receive and reconcile revenue and enrollment. As the principle leader of this area, the individual drives performance ensures oversight and appropriate financial and process controls and helps to enact strategy in building increased automation.? Critical to these accountabilities is electronic and written communication with CMS along with critical monthly reporting which is audited and monitored by CMS.? The position is accountable for consuming yearly revenue for the Health Plan in excess of $804 million dollars.In addition, the Director is also responsible for Broker commissions and related financial reporting, and controls over $9.27 million of commission payments per year.? Finally, The Director is also responsible for Mailroom print (+4.45 million pieces per year), mail (+500,000 pieces per year) and related operations for the HP.The director will provide Quality/No Harm, Customer Service and Stewardship by driving operational excellence in the billing/revenue and enrollment critical activities for our Commercial, Medicare, TPA and Individual members in a highly regulated and complex environment with within Federal and State Insurance regulations.Primary Accountabilities\:

  • Builds strong leadership driven to lean process management and total employee engagement.
  • Focuses on active employee engagement and problem resolution to improve the customers? experience.
  • Drives developmental activities for both leadership and staff. Creates a ?learning? organization.
  • Actively communicates key performance indicators and progress, organizational updates and all other communication to ensure associates are well connected with the Department(s) managed and the Health Plan activities.
  • Engages directly with Finance, Accounts Payable, IT to ensure proper financial controls and reporting in place.
  • Champions continuous improvement projects, specifically those projects with financial exposure and risk, improve customer experience and drive automated solutions to ensure Department is poised for growth in both revenue collections and membership.
  • Ensures all systems have appropriate controls in place, including check receipt, billing collection and reconciliation.
  • Ensure Broker Financial Services is able to meet monthly Broker Commission obligations.
  • Ensures Resource Center is able to meet daily print, mail and fulfillment needed for the HP.
  • Demonstrates acumen to ensure eligibility is accurate and entered into the system timely.
  • Protects PHI.
  • Operates the Department in compliance with all CMS, Insurance department, Federal and State regulations and guidelines.
  • Creates organizational wide awareness of world class Enrollment and Billing metrics
  • Strives to create actionable activities to improve the initial member experience from invoicing to receiving the ID card timely.
  • Ensures that Brokers/Agencies are paid timely and accurately for monthly and annual compensation and that service is exceptional to help drive Broker satisfaction and continued membership growth.
  • Inspires all associates to ?leap tall buildings? to ensure amazing customer experiences.
  • Directly accountable for all billing and receipt of payments and reconciliation activities totaling over $67 million per month (Commercial, QHP/APTC from CMS, Medicare premium from CMS?)
  • Directly accountable for processing Broker Commissions, resulting in approximately $650k in payments to Brokers each month.?
  • Ensure eligibility and enrollment records (paper, electronic) are entered, updated and reconciled timely and accurately.
  • Drives lean process model and technology focus to improve departmental efficiencies.
    • Bachelor?s Degree?
    • 15+ years progressive health care operations experience, preferred in an area directly related to enrollment and/or billing and reconciliation functions.

Keywords: Health First, Melbourne , Director Billing & Enrollment - Health Plan, Healthcare , Melbourne, Florida

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