Description

The Senior Enrollment Manager is responsible for the operations of the companies Enrollment Department which includes enrollment/disenrollment processing, maintenance of enrollment information and demographic changes (including coordination of benefit, Medicare Secondary Payer and Medicare Late Enrollment Penalty information), communicating with appropriate external organizations for all lines of business (including all post-application activities for Medicare, QUEST newborn follow-up and disability disenrollment tracking), TPL follow-up for all lines of business, QUEST 1179 submissions and follow-up, PDE enrollment corrections, plan transfers, 4Rx enrollments, LIS rate code maintenance/matching, maintaining enrollment segment accuracy between PBM system and QNXT. The Senior Enrollment Manager is responsible for training and supervising the Enrollment Department staff and monitoring all key processes and performance indicators to ensure compliance with contractual, regulatory, and company requirements.

Accountable for the proper administration of the Enrollment Department functions within company which includes the detailed monitoring of Medicare and QUEST enrollment transactions and processes.

Accountable for the integrity of enrollment data and accuracy of transmission to multiple systems (such as QNXT, PBM, 4Rx, CMS and any enrollment intermediary).

Responsible for process improvement within the Enrollment Department and working with other departments to improve interdepartmental processes impacting Enrollment Department workflows and productivity.

Responsible for working with Information Systems staff to automate enrollment processes and interfaces to improve the accuracy and efficiency of department operations. Includes processes for handling plan enrollment and disenrollment transactions, tracking/monitoring of Medicare ESRD members, generation of member notices, and development of monitoring reports.

Develop/oversee department performance standards, goals, priorities and budgets including the monthly reporting of variances to standards and budgets.

Supervision of Enrollment Department staff including ensuring the compliance with all CMS beneficiary communication requirements.

Establish and monitor production schedules consistent with CMS/QUEST timelines.

Manage relationship with any outside enrollment processing vendors, identifies and works to resolve any system processing issues.

Primary contact with enrollment sponsors (State Medicaid and CMS agencies) for information transfer and issue resolution.

Develop automated work process for plan rejections, CMS rejections, auto disenrollments, enrollments to incorporate audit reports and adherence to required notifications and timelines.

Responsible for apprising other departments of internal and external enrollment-related issues that may impact the organization and takes appropriate action to incorporate changes into day-to-day operations.

Responsible for apprising Senior Director of Plan Operations of the status of major activities and significant operational issues.

Responsible for staff training and development, maintenance of applicable company Enrollment Policies and Procedures, and maintenance of comprehensive Enrollment Department manuals and workflows.

Participate in organizational meetings, workgroups or assigning other departmental staff to participate, as appropriate

Participates in corporate operational strategic planning and problem solving.

Filling position vacancies/supervising

Interviewing potential new hires, along with the department Lead

Hiring/disciplinary actions/terminating

Ensuring that effective orientation of new hires to position and training for job function, including new hire training tracking and periodic documented re-training of all department staff is implemented by the department Lead

3 month / 12 month / JPR

Salary & bonus determinations

Maintaining up-to-date job descriptions

Scheduling staff including approving PTO requests, signing timesheets, and approving overtime

Establishing atmosphere of compliance with requirements within the department

Being aware and knowledgeable of key requirements (contractual, regulatory, accreditation) related to departmental and pertinent interdepartmental activities, and the reference materials supporting these

Ensuring that all Medicare member records are in compliance with CMS requirements and appropriate document is retained to demonstrate compliance during CMS reviews/audits

Ensuring all P&Ps required are kept up to date, accurate and meeting requirements

Monitor and publish departmental performance measures and compare results against requirements or other established benchmarks and institute corrections as necessary

Achieve department goals related to requirements or other established benchmarks

Identify interdepartmental and organizational interdependencies

Ensure smooth execution of key interdependencies (organizationally and departmental)

Signing off on check requests and invoices for departmental expenditures

Hold bi-weekly departmental meetings documented with minutes – including sharing non-confidential items of interests from organizational meetings

Perform duties of the department Lead during absences or vacancies

Special projects as assigned.

Other related duties as assigned.

Responsible to maintain company's confidential information in accordance with company policies, and state and federal laws, rules and regulations regarding confidentiality. Employees have access to company data based on the data classification assigned to this job title.

Additional Skills & Qualifications

Bachelor’s Degree in Business or related field; or high school graduate with at least 5 years related work experience

Minimum five years’ relevant work experience in health plan setting.

Minimum three years’ experience managing staff in a structured, production work environment.

Strong analytical skills and detail oriented.

Ability to problem solve, analyze, think critically, exercise sound judgment and make fair decisions.

Excellent interpersonal skills, with demonstrated ability to effectively train and interact with employees in all levels within the organization.

Ability to multi-task, adapt to changing priorities, manage a diversity of high priority projects in a fast-paced environment.

Ability to work independently and use initiative to set priorities and work schedules, and meet deadlines; capable of working on several projects concurrently under tight deadlines

Demonstrated leadership skills, including managing remote team members.

Advanced skills using Microsoft Programs; Word, Excel, Outlook and PowerPoint

Pay and Benefits

The pay range for this position is $85000.00 - $100000.00/yr.

Medical Plan (includes drug and vision coverage)
Dental Plan
401(k) Plan with employer match
Paid Time Off and Paid Holidays
Employee Recognition & Rewards Programs
Employee referral award bonus
Wellness Programs
Employee Assistance Program
Short-Term Disability and group life insurance
Flexible spending account for medical and dependent care

Workplace Type

This is a fully remote position.

Application Deadline

This position is anticipated to close on Jun 16, 2025.

Aston Carter provides world-class corporate talent solutions to thousands of clients across the globe. Specialized in accounting, finance, human resources, talent acquisition, procurement, supply chain and select administrative professions, we extend the capabilities of industry-leading companies. We draw on our deep recruiting expertise and expansive network to meet the evolving needs of our clients and talent community with agility and excellence. With offices across the U.S., Canada, Asia Pacific and Europe, Aston Carter serves many of the Fortune 500. We are proud to be a ClearlyRated Best of Staffing® double diamond winner for both client and talent service.

The company is an equal opportunity employer and will consider all applications without regard to race, sex, age, color, religion, national origin, veteran status, disability, sexual orientation, gender identity, genetic information or any characteristic protected by law.

If you would like to request a reasonable accommodation, such as the modification or adjustment of the job application process or interviewing process due to a disability, please email astoncarteraccommodation@astoncarter.com for other accommodation options.