Director Enrollment, Billing & Reconciliation

The Director of Enrollment, Billing and Reconciliation oversee the following functional areas: overall enrollment, eligibility and billing operations and all associated reconciliation functions across all products. The Director leads Enrollment, Billing & Reconciliation operations teams to ensure timely and accurate processing of eligibility, enrollment and billing transactions and processes, including but not limited to billing, premium collection, enrollment, effectuation, invoicing, change, disenrollment, reconciliation and other enrollment and eligibility related operations. The incumbent ensures the highest level of service is provided to members, customers and internal stakeholders while promoting member satisfaction and account retention. High level of engagement and collaboration with Market General Managers and internal stakeholder Executives is required. Additionally, the incumbent ensures regulatory compliance with all Centers for Medicare & Medicaid Services (CMS) Guidelines and Department of Health regulations as well as all associated offices. The Director remains flexible while utilizing strategic thinking and creativity to address challenges in alignment with long-term growth and profitability goals.

Key Accountabilities:

• Enrollment, Billing and Reconciliation Operations




• Understands and aligns with Medica's strategic vision and priorities. Collaborates with all levels of the leadership team, peers and business partners.
• Develops/designs enrollment, billing and reconciliation operations processes that align to the member and customer experience to ensure that service is the top priority.
• Proactively monitors operational performance. Initiates and drives appropriate change in processes, tools and capabilities that increase operational efficiency and effectiveness while concurrently improving the member/customer experience and complying with regulatory requirements.
• Achieves key performance metrics, including member satisfaction, quality, compliance, employee engagement and financial objectives.
• Identifies and resolves operational, organizational, and business problems that affect the Enrollment and Billing organization, including management of dependencies upstream and downstream and coordination with Technology Partners.
• Leverages Six Sigma and Lean methodology to support continuous improvements and oversight of the Enroll Value Stream with an enterprise mindset.
• Directs overall enrollment, billing and reconciliation operations, determines performance objectives/metrics, cost center budget and defines tools to measure progress, ensuring consistent achievement of business objectives. Presents timely, accurate and complete business plans, reports and presentations.




• Workforce Management




• Maintains and supports on-going workforce management processes and controls, focusing on quality and productivity, to ensure accurate and timely processing of Enrollment, Billing and Reconciliation transactions. Including maximizing global partnerships as part of the strategic staffing model.
• Monitors and reacts to Performance Indicators in area of responsibility. Structures and staffs a lean organization capable of meeting departmental objectives ensuring optimum performance through appropriate training, development, performance and motivation.




• People Leadership




• Builds and fosters relationships within a matrix organizational structure to proactively resolve enrollment/billing/eligibility issues and drive efficiencies.
• Leads and develops a high-performance, member/customer-centric management team and workforce. Inspires and motivates employees to deliver compassionate, efficient and effective service. Fosters a culture of accountability that emphasizes people and performance management, coaching and development, and employee engagement.

Qualifications:

• Bachelor's degree or equivalent experience in related field, plus 7 years of work experience in progressive health insurance operations management experience with an emphasis on enrollment, billing and reconciliation

Preferred Qualifications:

• Comprehensive knowledge of the health insurance industry, products/services, internal operations and related processing systems, and regulatory requirements
• Strong knowledge of payer enrollment functions, including Medicare Part B enrollment, PECOS, CAQH and all applicable regulatory requirements
• Knowledge of Commercial and/or Self-Funded and Individual enrollment application intake process and billing requirements
• Leadership experience in a high volume production billing, enrollment, claims, call center environment or related environment
• History of strong process improvement and/or engineering that yielded in efficiencies and translating those efficiencies into administrative cost savings
• A strong understanding of the SAFe framework and Agile methodologies and the ability to apply them effectively on a large scale is essential.
• Demonstrated ability to provide strong, dynamic leadership that mentors, develops and guides leaders and individual contributors
• A successful track record of developing and maintaining an effective organization of accountability including efficient staffing, workflow patterns, performance standards,
• Strong analytical skills with ability to drive transformational, consumer-centric change
• Experience with strategic, member-centric initiative development and implementation, including operating policies and procedures
• Strong verbal, written, interpersonal and presentation skills
• Vendor oversight and performance management experience
• Management and oversight of global partnerships
• Experience in budgeting/finance/cost accounting

This position is an Office role, which requires an employee to work onsite, on average, 3 days per week. We are open to candidates located near one of the following office locations: Minnetonka MN or Madison WI.

The full salary grade for this position is $111,200 - $190,600. While the full salary grade is provided, the typical hiring salary range for this role is expected to be between $111,200 - $166,740. Annual salary range placement will depend on a variety of factors including, but not limited to, education, work experience, applicable certifications and/or licensure, the position's scope and responsibility, internal pay equity and external market salary data. In addition to base compensation, this position may be eligible for incentive plan compensation in addition to base salary. Medica offers a generous total rewards package that includes competitive medical, dental, vision, PTO, Holidays, paid volunteer time off, 401K contributions, caregiver services and many other benefits to support our employees.

The compensation and benefits information is provided as of the date of this posting. Medica's compensation and benefits are subject to change at any time, with or without notice, subject to applicable law.

Eligibility to work in the US: Medica does not offer work visa sponsorship for this role. All candidates must be legally authorized to work in the United States at the time of application. Employment is contingent on verification of identity and eligibility to work in the United States.

We are an Equal Opportunity employer, where all qualified candidates receive consideration for employment indiscriminate of race, religion, ethnicity, national origin, citizenship, gender, gender identity, sexual orientation, age, veteran status, disability, genetic information, or any other protected characteristic.