Medica
Director Enrollment, Billing & Reconciliation
Medica, Hopkins, Minnesota, United States, 55305
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Director Enrollment, Billing & Reconciliation
role at
Medica
2 days ago Be among the first 25 applicants
The Director of Enrollment, Billing and Reconciliation oversees 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: Understand and align with Medica’s strategic vision and priorities, collaborate with leadership, develop and design processes that prioritize member and customer experience, proactively monitor performance, initiate process changes to increase efficiency while improving experience and compliance, achieve key performance metrics, resolve operational, organizational, and business problems, leverage Six Sigma and Lean methodology, direct overall operations, determine performance objectives, present business plans and reports.
Workforce Management: Maintain and support on‑going workforce management processes and controls, focus on quality and productivity, ensure accurate and timely processing of transactions, monitor and react to performance indicators, structure and staff a lean organization capable of meeting departmental objectives, ensure optimum performance through appropriate training, development, performance and motivation.
People Leadership: Build and foster relationships within a matrix organizational structure to resolve enrollment/billing/eligibility issues and drive efficiencies, lead and develop a high‑performance, member/customer‑centric management team and workforce, inspire and motivate employees to deliver compassionate, efficient and effective service, foster 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 progressive health insurance operations management experience with an emphasis on enrollment, billing and reconciliation.
Preferred: Comprehensive knowledge of the health insurance industry, regulatory requirements, strong process improvement and engineering experience, SAFe framework and Agile methodologies proficiency, experienced leadership in a high‑volume production billing, enrollment or claims environment, ability to drive transformational, consumer‑centric change, vendor oversight and performance management experience, budgeting and finance/cost accounting expertise.
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.
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.
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Director Enrollment, Billing & Reconciliation
role at
Medica
2 days ago Be among the first 25 applicants
The Director of Enrollment, Billing and Reconciliation oversees 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: Understand and align with Medica’s strategic vision and priorities, collaborate with leadership, develop and design processes that prioritize member and customer experience, proactively monitor performance, initiate process changes to increase efficiency while improving experience and compliance, achieve key performance metrics, resolve operational, organizational, and business problems, leverage Six Sigma and Lean methodology, direct overall operations, determine performance objectives, present business plans and reports.
Workforce Management: Maintain and support on‑going workforce management processes and controls, focus on quality and productivity, ensure accurate and timely processing of transactions, monitor and react to performance indicators, structure and staff a lean organization capable of meeting departmental objectives, ensure optimum performance through appropriate training, development, performance and motivation.
People Leadership: Build and foster relationships within a matrix organizational structure to resolve enrollment/billing/eligibility issues and drive efficiencies, lead and develop a high‑performance, member/customer‑centric management team and workforce, inspire and motivate employees to deliver compassionate, efficient and effective service, foster 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 progressive health insurance operations management experience with an emphasis on enrollment, billing and reconciliation.
Preferred: Comprehensive knowledge of the health insurance industry, regulatory requirements, strong process improvement and engineering experience, SAFe framework and Agile methodologies proficiency, experienced leadership in a high‑volume production billing, enrollment or claims environment, ability to drive transformational, consumer‑centric change, vendor oversight and performance management experience, budgeting and finance/cost accounting expertise.
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.
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.
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