Enrollment Manager – Central Valley Medical Services Corporation – Fresno, CA

Description:

Innovative Integrated Health Community Plans

WHO WE ARE:

IIH Community Plans is a mission-driven health plan serving Medicare beneficiaries in California. We deliver comprehensive, outcomes-driven care to those who need it most. We offer integrated managed care products, pharmaceutical benefit management and specialty pharmacy services, behavioral health services, and other administrative services.

By becoming a part of the IIH Community Plans team, you will provide members with the quality of care they deserve. We believe that great work comes from people who are inspired to be their best. We have built a team of talented and experienced people who are passionate about transforming the lives of the seniors we serve. In our rapidly growing company, you will find ample room for growth and innovation.

Responsibilities:

The Enrollment Manager is responsible for verifying and tracking all new plan enrollments and correcting any data discrepancies. This position will oversee the daily workflow of enrollment processes and ensure data is monitored and accurate information is disseminated between all involved parties including Sales and vendors. This position may include supervision of Enrollment staff. (Note: IIH Community Plans is a start-up entity and the incumbent will initially be expected to function as an individual contributor. Additional staff may be hired as the plan grows.)

Duties include, but are not limited to:

• Corresponding with Members or CMS (Center for Medicare and Medicaid Services) to gather information or provide updates for corrections
• Ensuring that all enrollments, denials and rejects meet Medicare guidelines (Chapter 2 Medicare Advantage Enrollment and Disenrollment manual)
• Responsibility and accountability for the training, and overall performance of Enrollment staff to ensure that all qualitative and quantitative goals and objectives are met within the department
• Ensuring regulatory compliance in all areas that affect the Enrollment Unit
• Creating, developing and implementing programs that may benefit the unit
• Ensuring daily TRR is validated and all transactions are reviewed
• Acting as a liaison to the Sales team and ensuring new enrollments are processed properly
• Identifying any enrollment issues and bringing to the attention of internal department heads as necessary
• Working with MSO to ensure appropriate entry of all enrollment applications as well as disenrollment into plan’s data system
• Contacting Physician/Specialist offices to obtain qualifying documentation as needed
• Tracking all pending enrollments for additional information needed for qualification
• Ensuring timely completion of departmental compliance tasks which include the Annual Notice of Change and all other necessary compliance mailings
• Overseeing training of employees; planning, assigning and directing work; assisting in the rewarding and disciplining of assigned employees; addressing complaints and resolving problems as they arise
• Creating and submitting reports to the leadership and membership teams
• Travel within the Central Valley area
• Attend and participate in staff meetings, in-services, projects, and committees as assigned.
• Adhere to and support the center’s practices, procedures, and policies including assigned break times and attendance.
• Accept assigned duties in a cooperative manner; and perform all other related duties as assigned.
• Be flexible in schedule of hours worked.
• May require use of personal vehicle

Competitive Benefits and Salary:

• Desirable work schedule
• Health Insurance Coverage (Medical, Dental and Vision)
• 401K
• Paid time off (including holidays, vacation and sick time)
• Competitive Salaries and bonuses
• Recruitment Referral Bonus Program
• Professional development opportunities
• Employee Recognition events and activities
• Please contact Human Resources for salary information

Location: Central Valley area (Fresno, Tulare, Kern counties), CA

. Requirements:

• Bachelor’s degree in business, health administration or related field required.
• Minimum of three (3) to five (5) years related experience in the health care field
• Minimum of two (2) to three (3) years customer service experience preferred
• Direct sales or related experience preferably in the managed care industry
• Knowledge of Medicare managed care plans required
• Bi-lingual (English/Spanish) strongly preferred
• Must be familiar with CMS, MMR, and TRR files