Enrollment Reconciliation Supervisor

Description

Position title: Enrollment Reconciliation Supervisor 

Reports to: Technical Operations Director 

FLSA status: Exempt

Position Summary 

The enrollment reconciliation team at Your Health Idaho works closely with internal and external partners to ensure alignment of consumer accounts, applications, and enrollment data, while also identifying and escalating trends impacting enrollment data quality. In this role you will oversee all day-to-day activities of the enrollment reconciliation team to ensure effective execution of team responsibilities. You will also provide support and guidance to the enrollment reconciliation team while performing a wide range of consumer support services to include responsibility for customer support services, case management, enrollment reconciliation and other related technical escalation functions.

Responsibilities (Position may include additional functions not listed)

• Oversee all day-to-day activities of a team of Enrollment Reconciliation (Recon) Specialists.
• Provide leadership and guidance to enable the Recon Team to effectively meet business and operational needs.
• Effectively monitor and maintain staff performance levels (i.e., quality, productivity, time management, report progress and completion, and other expectations of the team).
• Directly supervise the Enrollment Reconciliation Team, to include interviewing/hiring, training and coaching, scheduling and schedule adherence, quality/productivity metrics, performance management, and disciplinary situations.
• Complete monthly 1:1 meeting to ensure continued employee engagement with member of the Reconciliation Team
• Monitor, measure, analyze, and improve performance metrics.
• Monitor, track, assign and distribute Reconciliation team inventory/workload and conduct quality reviews of team case work.
• Process enrollment discrepancies as well as perform manual verifications and related projects.
• Be a primary point of contact for escalated case updates and provide updates to external partners, as needed.
• Utilize YHI’s technology platform to review and research relevant consumer information and resolve consumer concerns or questions.
• Troubleshoot and solve problems of a technical nature impacting the Reconciliation workstream and team
• Use analytic skills to create monthly scorecards on insurance carrier progress and present in meetings.
• Provide job specific training to new hires and insurance carrier partners on the reconciliation process.
• Oversee and participate in federal and local audits of enrollment records, including resolution of findings.
• Participate, present, and provide training in meetings with Insurance Carrier, technology vendors, and Federal partners such as the Centers for Medicaid and Medicare Services.
• Collaborate with internal and external partners on system defect
• identification, triage, escalation, and resolution based on understanding of YHI’s technology platform requirements.
• Collaborate, influence decisions, and resolve complex consumer support problems.
• Keep up to date on State and Federal regulations related to ACA.
• Support YHI’s carrier escalation process, carrier reconciliations, and carrier reconciliation metric reviews.
• Perform other duties as assigned.

Qualifications (Required knowledge, skills, abilities, education, experience, etc.)

• BA/BS preferred or equivalent through professional experience
• 2 years customer service experience, including resolving complex customer situations and responding to escalated cases
• Excellent verbal and written communication skills as well as ability to provide and receive constructive feedback
• Excellent leadership skills with demonstrated ability to lead a team
• Knowledge of the healthcare industry, the Affordable Care Act (ACA) and/or experience overseeing a healthcare-related program preferred
• Strong computer skills, including Microsoft suite, as well as ability to learn and utilize other technology applications
• Strong problem solving, reading comprehension, business analysis, and technical/business writing skills
• Ability to assume responsibility and maintain confidentiality consistent with the values and integrity of the Exchange.
• Detail oriented and the ability to reason logically and formulate ideas and opinions and be able to handle multiple priorities.
• Work effectively in a team environment, including demonstrated skills in exceptional interpersonal, collaboration, problem-solving, and communication.
• Ability to work effectively in a fast-paced, continually evolving environment and work independently with limited supervision.

Requirements

• Ability to work in office and workshop settings. Frequent facilitation of meetings, workshops, or group meetings. Use of normal office machines and specialized audio-visual equipment for presentations.
• Ability to listen to and understand others as well as ability to give and receive instructions via telephone, computer messages, face-to-face, and in writing. Must possess the ability to write and compose correspondence, memorandums, and reports manually and via computer or email as well as be able to make presentations.
• Availability to work additional hours or weekends as projects demand.

*The functions described herein are not the only responsibilities and tasks to be performed by the individual occupying this position. The individual will be required to follow any other instructions and to perform any other job-related duties as required by his/her supervisor or manager. Requirements stated herein are minimum levels of knowledge, skills, and/or abilities to qualify for this position. To perform the responsibilities of this position successfully, the individual will possess the abilities and aptitudes to perform each task proficiently. “Ability” means to possess and apply both knowledge and skill.