If you are unable to complete this application due to a disability, contact this employer to ask for an accommodation or an alternative application process.

Job Title: Program Manager, Medicare D-SNP Enrollment

Location: Camarillo, CA, US

Requisition ID: 1559

Salary Range: $88,594.00 To $147,656.00 Annually

The pay range above represents the minimum and maximum rate for this position in California. Factors that may be used to determine where newly hired employees will be placed in the pay range include the employee specific skills and qualifications, relevant years of experience and comparison to other employees already in this role.

Work Culture:

GCHP strives to create an inclusive, highly collaborative work culture where our people are empowered to grow and thrive. This philosophy enables us to create the health plan of the future and do our best work – Together.

GCHP promotes a flexible work environment. Employees may work from a home location or in the GCHP office for all or part of their regular workweek.

POSITION SUMMARY

The Program Manager, Medicare D-SNP Enrollment is responsible for enrollment activities to provide excellent service to potential and existing Duals Special Needs Plan (D-SNP) members and achieve enrollment goals.

1. Ensure the accurate, timely processing and data entry of Medicare enrollments into the GCHP D-SNP, re-enrollments and disenrollment, compliance with regulatory requirements relating to enrollments and disenrollment, filing of applications, prospect and member communication, and other related documents.
2. Address a variety of enrollment questions or concerns received via claims, call tracking, or email.
3. Maintain all records in the enrollment database.

ESSENTIAL FUNCTIONS

1. Responsible for preparation, timely processing of enrollment applications, management, and maintenance in accordance with CMS and DHCS regulations.
2. Oversees the enrollment activities and reconciliation.
3. Strong knowledge of the Enrollment process along with State, Federal, and business regulatory requirements.
4. Ensure quality control of data entered into membership database.
5. Oversee and participate in state, federal, and internal audits, as needed.
6. Responsible for the accurate and timely dissemination of eligibility data to the network, ancillary providers, and internal systems.
7. Ensures staff is compliant with regulatory and company guidelines, including HIPAA compliance.
8. Partners with the Chief, Member Experience to establish departmental goals and objectives.
9. Oversee and manage the auditing of enrollment and disenrollment information data.
10. Develop, create, and implement policies and procedures for the Medicare Enrollment department.
11. Responsible for ensuring timely reconciliation of eligibility files and adjustments to CMS.
12. Coordinate and manage the generation and mailing of all necessary correspondence relating to enrollment.
13. Provide excellent customer service to members and providers.
14. Educate members about health plan benefits and services.
15. Review and verify member Medi-Cal and/or Medicare eligibility.
16. Respond to eligibility inquiries from members and providers in a timely and professional manner.

MINIMUM QUALIFICATIONS

1. Bachelor's degree in healthcare administration or health care related field.
2. A minimum of 3-4 years Enrollment Processing related experience in a Medicare setting.
3. Experience with processing of standard enrollment and eligibility files.
4. Proficient with Microsoft Office applications.
5. Detail oriented with problem-solving abilities.
6. Exemplary interpersonal and customer service skills.
7. Proven leadership with staff, projects, and management.

PREFERRED QUALIFICATIONS

1. At least 6 years of experience in a Medicare enrollment or eligibility position.

#J-18808-Ljbffr