Bpaas Enrollment & Premium Team Lead

The BPaaS Enrollment & Premium Lead will be assigned to lead the operational area for Medicare and Medicaid Clients including planning, organizing, and managing the processes to deliver outcomes aligned with operational and contractual commitments. This position requires a seasoned professional with outstanding judgment, leadership, communication and interpersonal skills. The position requires strategic thinking, decision-making ability and formal responsibility for meeting business goals. Candidates need strong operational management experience and the ability to monitor and manage multiple client’s outcomes concurrently, as well as demonstrate excellent staff management skills. 

Role and Responsibilities

• Day to day tasks will include

  • Working complex and escalated cases

  • Preparation of justification statements and supporting documentation packets for member advocacy cases

  • Interfacing with CMS and clients through data file sharing, uploads and emails

  • Approval and submission of member correspondence

  • Managing the monthly premium billing cycle for all clients

  • Provide expertise in enrollment and premium billing regulations and decisions with the management team

  • Provide training to new staff and perform coaching when needed

  • Process transactions 50-60% of the day

• Develop / maintain department policies and procedures, workflows, handoff processes, etc.

• Leading touchpoint and call calibration meetings, asking questions, educating regarding processes and practices, and articulate expectations.

• Assisting other management team members in identifying trends and establishing goals.

• Ensuring staff members achieve desired service levels and taking corrective action, as needed.

• Preparing reports and analyzing call center data to improve processes, ensure resources are properly allocated, and maximize efficiency and customer satisfaction.

• Taking on other tasks or projects to support the department.

• Assess reporting needs for responsible functions and determine how best to operationalize a metric driven approach to managing the department and client outcomes.

• Assist in ensuring the service offering can tactically be delivered against contractual, regulatory and financial expectations.

• Implement a continuous improvement plan to identify opportunities for improvements in technology and process to drive the most efficient outcomes including use of robotic automation.

• Assist with implementations as needed.

• Other duties as assigned

Requirements

• Industry Experience: 5+ years in healthcare industry experience working in the enrollment and/or member premium billing segment in Medicare Advantage, Managed Medicaid or working with an industry competitor.  BPaaS experience is a plus.
• Skills & Knowledge:  Word, Excel, PowerPoint (MS Access is a plus). Exceptional interpersonal, listening, written and oral communication abilities are a must. Candidate must have subject matter expertise with back office healthcare enrollment and billing products.
• Must possess strong operational management skills as well as the ability to interact directly with internal departments and clients.  Able to oversee and deliver results across multiple clients is also required.
• Knowledge of the healthcare industry and BPaaS operations are pluses.
• Years of Experience: 3 years
• Education: High school diploma or equivalent.
• Certifications/Licenses: Healthcare industry certifications a plus.
• Travel Requirements: None
• Number of Clients Supported: Multiple

  

Note: This job description is intended to convey information essential to understanding the scope of the position and is not an exhaustive list of efforts, duties, responsibilities, or working conditions associated with it. Duties, responsibilities, and activities may change at any time with or without notice.