Enrollment Supervisor

Prominence Health is a value-based care organization bridging the gap between affiliated health systems and independent providers, building trust and collaboration between the two. Prominence Health creates value for populations and providers to strengthen integrated partnership, advance market opportunities, and improve outcomes for our patients and members. Founded in 1993, Prominence Health started as a health maintenance organization (HMO) and was acquired by a subsidiary of Universal Health Services, Inc. (UHS) in 2014. Prominence Health serves members, physicians, and health systems across Medicare, Medicare Advantage, Accountable Care Organizations, and commercial payer partnerships. Prominence Health is committed to transforming healthcare delivery by improving health outcomes while controlling costs and enhancing the patient experience.

Learn more at: https://prominence-health.com/

Job Summary:

The Supervisor of Enrollment is responsible for overseeing the day-to-day operations of the Medicare Enrollment team. This role ensures compliance with the latest CMS rules and regulations, leverages technology to streamline processes, and enhances member satisfaction through innovative solutions. The Supervisor will develop and implement policies and procedures, manage reconciliation and escalations, and collaborate with various internal and external entities

• Familiar with all enrollment requirements for NCQA/HEDIS and assures compliance with each standard. Prepares all NCQA and HEDIS reports required for audits and accreditation. Meets all reporting deadlines.
• Oversee the accurate and timely submission of enrollment applications.
• Monitor and resolve CMS Daily Transaction Reply Reports (DTRR), identifying actionable items and addressing issues
• Provides weekly, monthly and annual enrollment performance reports for Health Care Operations Committee (HCOC), Medical Advisory Committee (MAC) and PHP Board meetings. Conducts presentation of these reports to various committees on a quarterly basis,
• Collaborate with IT to ensure seamless integration of enrollment processes with other departments.
• Has direct oversight of enrollment, premium billing and reconciliation processes and all related staff
• Works closely with Sales and Underwriting departments to ensure new groups and renewals are completely timely and contain all needed elements for a successful execution
• Works with employer groups and brokers as needed to ensure the highest levels of member satisfaction
• Works with Marketing Team produce member enrollment books that are accurate and timely for members. Introduce and execute updated and electronic versions of member communications where possible.
• Oversee ID card processes, including template management, printing, and reprinting for active participants
• Performs annual evaluations, conducts interviews, oversees disciplinary problems and identifies staff for future growth opportunities
• Manages staff schedules including all PTO, lunch and break schedules, and FMLA to assure adequate enrollment coverage at all times.
• Establishes back-up staffing plans for critical volume or unexpected staffing impacts. Makes recommendations to the department director related to staffing needs.
• Responsible for ensuring members' rights and responsibilities are maintained and customer service standards are enforced at all times.
• Responsible for implementing (as needed) and assuring annual updating of all enrollment policies and procedures with a direct focus on improving quality, documenting processes, and enhancing service and productivity.
• Responsible for complying with principles and practices of health care rules and laws to ensure all time frames are met.
• Supplies updates and required reporting to CMS account management team and ensures all CMS and DOI guidelines are followed.
• Identifies and addresses PHP operations process improvement based on trends seen in employer, member and broker feedback and creates resolution tactics needed for process improvement.
• Address member complaints and grievances promptly using modern resolution techniques
• Manages PCP assignment process and ongoing tracking and callbacks with ongoing reporting of PCP assignment status.
• Manage annual enrollment budget including all staff and major line items such as member booklet and ID cards and other member communications.
• Maintain up-to-date knowledge of Medicare policies and procedures and provide ongoing training and development opportunities for staff to keep up with industry changes.
• Submit responses to Enrollment Data Validation (EDV) requests, analyze EDV response data, and manage dispute resolution.
• Monitor CMS Late Enrollment Penalty (LEP) reports and track LEP status for Medicare-only participants to ensure accurate billing and compliance with CMS requirements
• Review monthly and annual COB/MSP reports to ensure participant records are accurate for claims processing, submitting corrections through ECRS when discrepancies are identified.
• Perform other duties or special projects as assigned.
• Generate and submit monthly files to Risk Adjustment vendor, including but not limited to Eligibility File, MAO004, MMR, MOR, MSPCOBMA, PTDMODD.
• Generate and submit monthly files to PDAC, including but not limited to PTDMODR, PTDMODD, HCCMODD, HCCMODR, MAO004, MONMEMD.
• Monitor hospice status changes on DTRR reports and coordinate appropriate disenrollments or corrections, including re-enrollment actions when hospice designations are inaccurate.
• Collaborate with PACE Center staff and state agencies as needed, based on state-specific Medicaid or dual enrollment processes

Benefit Highlights:

• Loan Forgiveness Program
• Challenging and rewarding work environment
• Competitive Compensation & Generous Paid Time Off
• Excellent Medical, Dental, Vision and Prescription Drug Plans
• 401(K) with company match and discounted stock plan
• SoFi Student Loan Refinancing Program
• Career development opportunities within UHS and its 300+ Subsidiaries! * More information is available on our Benefits Guest Website: benefits.uhsguest.com

About Universal Health Services:

One of the nation's largest and most respected providers of hospital and healthcare services, Universal Health Services, Inc. (UHS) has built an impressive record of achievement and performance. During the year, UHS was again recognized as one of the World's Most Admired Companies by Fortune; and listed in Forbes ranking of America's Largest Public Companies. Operating acute care hospitals, behavioral health facilities, outpatient facilities and ambulatory care access points, an insurance offering, a physician network and various related services located all over the U.S. States, Washington, D.C., Puerto Rico and the United Kingdom. www.uhs.com

Qualifications and Requirements:

• 2 years of supervisory experience in Medicare enrollment and reconciliation required.
• Working knowledge of CMS systems, CMS contracted vendors and reports including MARx, EDV, MMR, Retroactive Processing Contractor (RPC),Gentran, LEP and LIS
• At least 3 years' experience working with health plans insurance products or employer healthcare benefits programs.
• Bachelor's degree or equivalent experience preferred.
• Knowledge of State and Federal regulations as they pertain to the health insurance industry and Medicare enrollment policies and regulatory requirements.
• Proficiency in analyzing enrollment and payment files, with strong attention to detail
• Previous experience reviewing and analyzing statistical data to identify trends as well as potential problems/opportunities for improved service quality.
• Excellent verbal and written communication skills as well as public speaking and training abilities and experience

Skills:

• Knowledge of various computer systems including all Microsoft Office systems, Outlook, and budgetary, time and attendance type software systems.
• Strong processes improvement skills necessary to get things done
• Knows how to organize people and activities
• Understands how to separate and combine tasks into efficient workflow
• Knows what to measure and how to measure it
• Can see opportunities for synergy and integration where others can't
• Can simplify complex processes
• Gets more out of few resources

EEO Statement

All UHS subsidiaries are committed to providing an environment of mutual respect where equal employment opportunities are available to all applicants and teammates. UHS subsidiaries are equal opportunity employers and as such, openly support and fully commit to recruitment, selection, placement, promotion and compensation of individuals without regard to race, color, religion, age, sex (including pregnancy, gender identity, and sexual orientation), genetic information, national origin, disability status, protected veteran status or any other characteristic protected by federal, state or local laws.

We believe that diversity and inclusion among our teammates is critical to our success.

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