JOB DESCRIPTION Job Summary Leads and manages team responsible for member enrollment activities. Collaborates with internal and external partners - leveraging expertise and knowledge of enrollment function to resolve member enrollment/eligibility issues. **Essential Job Duties** • Demonstrates oversight for the enrollment team including but not limited to hiring, training, coaching, production and performance. • Oversees day-to-day functions of enrollment production, scheduling, monitoring, reporting and corrective action/escalations. • Represents as the primary point of contact for the internal partners, i.e. Medicare administration, compliance and health plan operations - coordinating and facilitating meetings, and providing appropriate documentation and follow-up on action items. • Informs leadership of potential risks, and provides input on possible mitigation steps and implements changes. • Ensures staff follow enrollment processes and established guidelines, and provides appropriate follow-up on peer review findings. • Identifies and communicates opportunities for enrollment process improvement to leadership. • Demonstrates knowledge of state, federal, and business regulatory requirements, strong knowledge of the internal system, and knowledge of other state-specific applications related to managed care enrollment. • Ensures timely reconciliation of eligibility files and meets regulatory and health plan requirements. • Documents and maintains department enrollment-related workflows, job aids and policies, and provides appropriate staff training accordingly. • Records and manages enrollment issues and collaborates with other business partners to resolve and communicate solutions as needed. • Communicates and follows-up on files delayed by state, or issues with enrollment files that require state involvement. • Partners with vendor management team and external vendors to ensure service level agreements (SLAs) and regulatory requirements are met. • Considers downstream and upstream impacts to other departments related to enrollment changes, and coordinates with center of excellence team as needed. • Coaches and mentors staff, and ensures goal setting and enrollment score card development processes are facilitated. • Monitors and enforces compliance with enterprise-wide processes and develops departmental workflows accordingly. • Oversees maintenance of processes and procedures for enrollment function, including monthly reporting for leadership. • Completes analysis of data to ensure accuracy and oversight of data entered through both automated processes and manual inputs. • Ensures quality control of data entered into internal system/sent to external vendors. • Oversees and participates in state, federal, and internal enrollment-related audits as needed. • Participates in process improvement initiatives to improve enrollment operations. • Demonstrates understanding of compliance and regulatory guidelines for each state/health plan. • Collaborates with both corporate and health plan partners as a subject matter expert for enrollment process initiatives/implementations. • Participates in enrollment-related meetings/calls with state agencies. • Ensures succession plan is in place, and coaches/mentors high potential staff. • Ensures staff is compliant with regulatory and company guidelines, including Health Insurance Portability and Accountability (HIPAA). **Required Qualifications** • At least 7 years of experience in health care, including at least 4 years of enrollment experience in a managed care setting, or equivalent combination of relevant education and experience. • At least 1 year of management/leadership experience. • Knowledge of managed care rules, regulations and benefits. • Strong customer service experience. • Strong organizational and time-management skills, and ability to multi-task. • Problem-solving skills, and ability to collaborate cross-functionally across a highly matrixed organization. • Ability to maintain confidentiality and comply with the Health Insurance Portability and Accountability Act (HIPAA). • Team oriented and strong sense of customer focus. • Ability to establish and maintain positive and effective work relationships with coworkers, members, providers and customers. • Strong verbal and written communication skills. • Microsoft Office suite and applicable software programs proficiency. To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V Pay Range: $60,415 - $117,809 / ANNUAL *Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.