Job Description

Job Title: Senior Manager, Enrollment Services - Government
Job ID: 634121
Status: Full-Time
Regular/Temporary: Regular
Hours:
Shift: Day
Facility:
Department: GOVT ENROLLMENT
Location: 600 Grant St, Pittsburgh PA 15219

Description

Are you a strong leader with a background in health plan operations and enrollment? If so, an opportunity as a Senior Manager of Enrollment Services with UPMC Health Plan may be the perfect fit for you!

 

Under the general direction of the Director of Enrollment and Member Services, the Senior Manager of Enrollment Services assumes responsibility for directing all activities related to enrollment, reconciliation, and coordination of benefits for all lines of business. This position is responsible for providing leadership and direction to manager level staff to meet or exceed UPMC Health Plan business objectives.  This position will work a daylight schedule.  Some travel may be required.

Responsibilities:

  • Analyze and trend data to identify inefficiencies and implement process improvement;
  • Assist in the development/refinement of policies and procedures;
  • Continuously evaluate and document business needs to assure systematic processes are being leveraged to optimize business efficiencies.
  • Control expenses while meeting operational, financial, and service requirements in a fast-paced managed care operations environment;
  • Coordinate Enrollment Services participation for all internal & external audits as necessary;
  • Evaluate contracted vendor(s) on a periodic basis to determine if contractual obligations are being met and products/services are required;
  • Identify areas of potential compliance risk and develop solutions for risk mitigation;
  • Identify critical business objectives; develop and implement business plans to support critical objectives
  • Interact extensively with internal and external customers to build and maintain positive relationships supporting business goals and regulatory compliance;
  • Lead workgroups that encompass end users, developers, and others to identify problems and implement solutions;
  • Maintain a positive work environment for direct reports, including Supervisors and Managers, with line staff (exempt & nonexempt) of up to 100;
  • Maintain compliance accountability specific to enrollment and coordination of benefits in accordance with state and federal law(s);
  • Manage Enrollment Services budget in excess of ($2,000,000);
  • Oversee the Commercial/CHIP/adultBasic Enrollment, Medicare Enrollment and Reconciliation, and Coordination of Benefits teams;
  • Participate in all phases of the recruitment and management of staff;
  • Prepare attestations and other regulatory documents for submission to CMS;
  • Provide leadership and direction, support professional growth by providing training opportunities and appropriate resources;
  • Reconcile Medicare Secondary Payer information. Responsible for identifying causes for variance and recommending corrective action interventions, systemic solutions or necessary short term actions.
  • Serve as a process expert by demonstrating operations activities to prospective clients and maintaining communication with established clients;

Qualifications

  • Bachelors Degree in Business or Health Care preferred, or a minimum of 7 to 10 years direct experience in Managed Care and/or Indemnity Insurance required
  • Working knowledge of Medicare and Medicaid regulations required;
  • Expert knowledge of Managed Care Operations, specifically Enrollment and coordination of benefits is required;
  • Medicare Advantage experience highly preferred
  • Health insurance/plan operations experience is highly preferred
  • Five years management experience preferred
  • Experience in multi-million dollar budget preparation preferred
  • Proficient of Microsoft Office products and PC skills required;
  • Proven process improvement and project management expertise required
  • Demonstrated ability to effectively influence others to accomplish Health Plan business objectives

    Licensure, Certifications, and Clearances:
    UPMC is an equal opportunity employer. Minority/Females/Veterans/Individuals with Disabilities

Salary Range: $32.95 to $55.80

Union Position: No

At UPMC, our shared goal is to create a cohesive, positive, experience for our employees, patients, health plan members, and community. If you too are driven by these values, you may be a great fit at UPMC!

QUALITY & SAFETY
DIGNITY & RESPECT
CARING & LISTENING
RESPONSIBILITY & INTEGRITY
EXCELLENCE & INNOVATION

UPMC provides a total rewards package that can help you achieve the goals you have for your career and your personal life. Whether you want to learn a new skill through a training course, reach personal health and wellness targets, become more involved in your community, or follow a career path that provides you with the right experience to be successful, UPMC can help you get to where you want to be.



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