Director, Enrollment & Operations
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POST DATE 9/9/2016
END DATE 10/23/2016
CareFirst BlueCross BlueShield
Owings Mills, MD
JOB DESCRIPTIONAPPLY The Director, Enrollment, Operation will be accountable for the enrollment, billing and collections, client services processes and operations support for all small medium business at CareFirst (1-199 and 200+ accounts this individual will ensure that the enrollment and billing operations are executed in a high quality, repeatable, and efficient manner. The position provides leadership to reengineer and implement new processes and systems to move the organization towards highly automated processes. The Director will also design the enrollment and billing operations to ensure the highest level of customer satisfaction and retention. This role also has the responsibility in managing the day to day activities required through its enrollment and billing operational support area including implementing all mandates and enhanced systems finally, this role will be held accountable for proactively changing the system and processes in accordance with Federal Health Care Reform. This will include designing and implementing any enrollment, billing and/or collection related tools required for Health Insurance. This position serves as the relationship manager with senior executive management both internally and externally, including the CEO, EVP, Healthcare Analytics, and key regulatory and legislative personnel.
1. Enrollment and Operations - Oversees the processing of small mid-market enrollment and analyzing accounts receivables, inventories, timeliness, accuracy, productivity, cost, appeals, and complaints. Ensure that all problems or issues encountered are resolved appropriately and in a timely manner in order to achieve and sustain high levels of customer satisfaction, and that all procedures and guidelines are followed.
2. Technological Reengineering - Provide business leadership and be the primary accountable owner for continuously improving the enrollment and billing processes and systems. A major focus in this effort will be driving self-service by accounts and brokers to improve customer satisfaction and reduce costs. This will include robust processes in ebilling-esales and automation of contract generation The director will be accountable for driving adoption of these automated methods among the customer base. This also includes the managing of the day to day operational support team in achieving outcomes in order to gain operational efficiencies throughout the EAB area
3. Process Design and Reengineering - Establish the necessary enrollment, billing and collections capabilities as the various components of Federal health reform are implemented. Work will include collaborating with each local jurisdiction and Health Exchange to ensure that all exchange groups experience accurate and efficient enrollment billing and collections and receive the appropriate Design, develop, plan and prioritize operational functions to meet overall strategic goals and objectives with focus on multi-state preparedness and consumerism as it relates to the future health exchange driven market.
4. Function as the CareFirst relationship manager and liaison with internal and external stakeholders for trading partners. Direct the activities of enrollment/billing data to strategically determine the allocation of staff, training needs, and improve current process to consistently exceed all performance expectations. Responsible for identifying and resolving corporate issues involving respective departments. The position ensures the attainment of goals by developing, approving and implementing operational strategies, plans and objectives, monitoring and ensuring the efficiency and effectiveness of the operation, evaluating work flows, procedures, policies and staffing needs, and always adhering to external, corporate and customer/provider standards for quality, timeliness and accuracy.
5. Coach and mentor staff to improve performance, ensure career growth and succession planning
6. Research and maintain strong knowledge of industry technology and related operational best practices in the areas of enrollment, billing and collections. Champion, collaborate with or advise peers and executive management on the formulation and decision-making of strategies, goals and recommendations that advance CareFirst s enrollment, billing and collection capabilities. Participates in corporate operations projects in order to achieve and maintain efficiency and quality standards.
* Bachelor s Degree in an industry-related field and/or equivalent experience in the healthcare or similar industry and job function.
* 8-10+ years of progressive management experience in a technologically focused operational environment
* Proven experience to manage day-to-day operational service, enrollment, billing and/or collection processes.
* Proven experience envisioning and implementing new high impact billing capabilities.
* Proven experience negotiating, implementing/enhancing and managing external vendor partnerships and technological capabilities.
* Experience interacting with VP/SVP/EVP levels of management and all their staff on a daily basis.
* Must be able to effectively work in a fast paced environment with frequently changing priorities, deadlines, and workloads that can be variable for long periods of time.
* Must be able to meet established deadlines and handle multiple customer service demands from internal and external customers, within set expectations for service excellence.
* Must be able to effectively communicate and provide positive customer service to every internal and external customer, including customers who may be demanding or otherwise challenging.
* Excellent written and oral communication and interpersonal skills
* Adept at managing core operations and process and technology improvements
* Must possess strong business acumen, strategic thinking, analytical, organizational, and planning skills
* Strong ability to lead others (direct and indirect) - motivate, negotiate, and persuade others
* Ability to identify and manage numerous shifting priorities, deadlines and resource issues to achieve results
* Master s Degree in Business, Info Systems or equivalent in healthcare or similar industry
* e-Commerce experience
The physical demands described here are representative of those that must be met by an associate to perform the essential duties and responsibilities of the position successfully. Requirements may be modified to accommodate individuals with disabilities.
The associate is primarily seated while performing the duties of the position. Occasional walking or standing is required. The hands are regularly used to write, type, key and handle or feel small controls and objects. The associate must frequently talk and hear. Weights of up to 25 pounds are occasionally lifted.
Department: SM SBU AI EAB Administration
CareFirst BlueCross BlueShield is an Equal Opportunity (EEO) employer. It is the policy of the Company to provide equal employment opportunities to all qualified applicants without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, protected veteran or disabled status, or genetic information.
Actual salary will be based on relevant job experience and work history.
Please visit our website to apply: www.carefirst.com/careers
Please apply before: October 21, 2016
Note: The incumbent is required to immediately disclose any debarment, exclusion, or other event that makes him/her ineligible to perform work directly or indirectly on Federal health care programs.
Must be eligible to work in the U.S. without Sponsorship
CareFirst BlueCross BlueShield is an Equal Opportunity / Affirmative Action employer. All qualified applicants will receive consideration for employment without regard