HealthCHEC
Enrollment, Reconciliation Operations Supervisor
HealthCHEC, Long Beach, California, us, 90899
Enrollment, Reconciliation Operations Supervisor
About SCANSCAN Group is a not-for-profit organization dedicated to tackling the most pressing issues facing older adults in the United States. SCAN Group is the sole corporate member of SCAN Health Plan, one of the nation's leading not-for-profit Medicare Advantage plans, serving more than 270,000 members in California, Arizona, and Nevada. SCAN has been a mission-driven organization dedicated to keeping seniors healthy and independent for more than 40 years and is known throughout the healthcare industry and nationally as a leading expert in senior healthcare. SCAN employees are a group of talented, passionate professionals who are committed to supporting older adults on their aging journey, while also innovating healthcare for seniors everywhere. Employees are provided with in-depth training and access to state-of-the-art tools necessary to do their jobs, as well as development and growth opportunities. SCAN takes great pride in recognizing our team members as experts in their fields and rewarding them for their efforts. If you are interested in becoming part of an organization that is innovating senior healthcare visit www.thescangroup.org, www.scanhealthplan.com, or follow us on LinkedIn, Facebook, and Twitter.
The jobResponsible for the day-to-day supervision of the Enrollment Operational Specialist staff and all Department Training activities related in accordance with Medicare Centers of Medicare Services (CMS) and Medi-Cal Department of Health Care Services (DHCS) guidance and regulations for all states of business.
You will
Creates, maintains, implements and oversees all training material and training of staff ensuring all department operations are at the level necessary to meet established guidelines and regulatory requirements.Monitors the work between cross-functional business areas within Enrollment by coordinating support to Enrollment, Reconciliation, and Premium Billing (ERPB) team.Keeps abreast of changes to legislation and regulations which pertain to health insurance procedures.Contributes to the yearly review and edits of all Annual Notice of Change (ANOC), Evidence of Coverage (EOC), Provider Operations Manual (POM) and Sales Training Documents assigned to the ERPB as a business owner.Improves processes by evaluating existing membership processing and payment reconciliation data workflows and offering suggestions to Management on implementation or monitoring guidelines for software programs to ensure optimum reconciliation revenue is captured.Overseer's the Complaint Tracking Module (CTM) complaints and grievances workflow, assigns work responsibilities and tasks, and prioritizes deliverables to meet regulatory requirements.Fields escalated issues and non-routine questions, providing guidance and direction to team including working with co supervisors and department leads on other business teams within department.Oversees the preparation of reports by collecting, analyzing, and summarizing information and trends; recommending to management a course of action. In addition to fulfill audit requests as needed.Accomplishes staff results by communicating job expectations; planning, monitoring, and appraising job results.Maintains staff job results by coaching, counseling, and disciplining employees; planning, monitoring and appraising job results.Actively support the achievement of SCAN's Vision and Goals.Other duties as assigned.Your qualifications
Bachelor's degree or equivalent experienceRequired A comparable combination of education/experience and/or training will be considered equivalent to the education listed above.3+ years of relevant experience in the healthcare industryDemonstrated supervisory experienceExperience in healthcare (Medicare Advantage HMO) is preferredStrong understanding of Medicare and Medicaid regulatory processes and requirementsStrong analytical skills preferreIntermediate to advanced knowledge of ExcelStrong verbal and written communication skills.Ability to communicate effectively within direct reports, management, and other stakeholdersStrong customer service skillsAbility to manage multiple responsibilitiesWhat's in it for you?
Base Salary range: $58,200.00 - $93,100.00An annual employee bonus programRobust Wellness ProgramGenerous paid-time-off (PTO)Eleven paid holidays per year, plus 1 additional floating holidayExcellent 401(k) Retirement Saving Plan with employer match.Robust employee recognition programTuition reimbursementA work-life balance
An opportunity to become part of a team that makes a difference to our members and our community every day!
We're always looking for talented people to join our team! Qualified applicants are encouraged to apply now!
At SCAN we believe that it is our business to improve the state of our world. Each of us has a responsibility to drive Equality in our communities and workplaces. We are committed to creating a workforce that reflects our community through inclusive programs and initiatives such as equal pay, employee resource groups, inclusive benefits, and more.SCAN is proud to be an Equal Employment Opportunity and Affirmative Action workplace. Individuals seeking employment will receive consideration for employment without regard to race, color, national origin, religion, age, sex (including pregnancy, childbirth or related medical conditions), sexual orientation, gender perception or identity, age, marital status, disability, protected veteran status or any other status protected by law. A background check is required. #LI-JR1
Equal Opportunity Employer/Protected Veterans/Individuals with Disabilities
The contractor will not discharge or in any other manner discriminate against employees or applicants because they have inquired about, discussed, or disclosed their own pay or the pay of another employee or applicant. However, employees who have access to the compensation information of other employees or applicants as a part of their essential job functions cannot disclose the pay of other employees or applicants to individuals who do not otherwise have access to compensation information, unless the disclosure is (a) in response to a formal complaint or charge, (b) in furtherance of an investigation, proceeding, hearing, or action, including an investigation conducted by the employer, or (c) consistent with the contractor's legal duty to furnish information. 41 CFR 60-1.35(c)
About SCANSCAN Group is a not-for-profit organization dedicated to tackling the most pressing issues facing older adults in the United States. SCAN Group is the sole corporate member of SCAN Health Plan, one of the nation's leading not-for-profit Medicare Advantage plans, serving more than 270,000 members in California, Arizona, and Nevada. SCAN has been a mission-driven organization dedicated to keeping seniors healthy and independent for more than 40 years and is known throughout the healthcare industry and nationally as a leading expert in senior healthcare. SCAN employees are a group of talented, passionate professionals who are committed to supporting older adults on their aging journey, while also innovating healthcare for seniors everywhere. Employees are provided with in-depth training and access to state-of-the-art tools necessary to do their jobs, as well as development and growth opportunities. SCAN takes great pride in recognizing our team members as experts in their fields and rewarding them for their efforts. If you are interested in becoming part of an organization that is innovating senior healthcare visit www.thescangroup.org, www.scanhealthplan.com, or follow us on LinkedIn, Facebook, and Twitter.
The jobResponsible for the day-to-day supervision of the Enrollment Operational Specialist staff and all Department Training activities related in accordance with Medicare Centers of Medicare Services (CMS) and Medi-Cal Department of Health Care Services (DHCS) guidance and regulations for all states of business.
You will
Creates, maintains, implements and oversees all training material and training of staff ensuring all department operations are at the level necessary to meet established guidelines and regulatory requirements.Monitors the work between cross-functional business areas within Enrollment by coordinating support to Enrollment, Reconciliation, and Premium Billing (ERPB) team.Keeps abreast of changes to legislation and regulations which pertain to health insurance procedures.Contributes to the yearly review and edits of all Annual Notice of Change (ANOC), Evidence of Coverage (EOC), Provider Operations Manual (POM) and Sales Training Documents assigned to the ERPB as a business owner.Improves processes by evaluating existing membership processing and payment reconciliation data workflows and offering suggestions to Management on implementation or monitoring guidelines for software programs to ensure optimum reconciliation revenue is captured.Overseer's the Complaint Tracking Module (CTM) complaints and grievances workflow, assigns work responsibilities and tasks, and prioritizes deliverables to meet regulatory requirements.Fields escalated issues and non-routine questions, providing guidance and direction to team including working with co supervisors and department leads on other business teams within department.Oversees the preparation of reports by collecting, analyzing, and summarizing information and trends; recommending to management a course of action. In addition to fulfill audit requests as needed.Accomplishes staff results by communicating job expectations; planning, monitoring, and appraising job results.Maintains staff job results by coaching, counseling, and disciplining employees; planning, monitoring and appraising job results.Actively support the achievement of SCAN's Vision and Goals.Other duties as assigned.Your qualifications
Bachelor's degree or equivalent experienceRequired A comparable combination of education/experience and/or training will be considered equivalent to the education listed above.3+ years of relevant experience in the healthcare industryDemonstrated supervisory experienceExperience in healthcare (Medicare Advantage HMO) is preferredStrong understanding of Medicare and Medicaid regulatory processes and requirementsStrong analytical skills preferreIntermediate to advanced knowledge of ExcelStrong verbal and written communication skills.Ability to communicate effectively within direct reports, management, and other stakeholdersStrong customer service skillsAbility to manage multiple responsibilitiesWhat's in it for you?
Base Salary range: $58,200.00 - $93,100.00An annual employee bonus programRobust Wellness ProgramGenerous paid-time-off (PTO)Eleven paid holidays per year, plus 1 additional floating holidayExcellent 401(k) Retirement Saving Plan with employer match.Robust employee recognition programTuition reimbursementA work-life balance
An opportunity to become part of a team that makes a difference to our members and our community every day!
We're always looking for talented people to join our team! Qualified applicants are encouraged to apply now!
At SCAN we believe that it is our business to improve the state of our world. Each of us has a responsibility to drive Equality in our communities and workplaces. We are committed to creating a workforce that reflects our community through inclusive programs and initiatives such as equal pay, employee resource groups, inclusive benefits, and more.SCAN is proud to be an Equal Employment Opportunity and Affirmative Action workplace. Individuals seeking employment will receive consideration for employment without regard to race, color, national origin, religion, age, sex (including pregnancy, childbirth or related medical conditions), sexual orientation, gender perception or identity, age, marital status, disability, protected veteran status or any other status protected by law. A background check is required. #LI-JR1
Equal Opportunity Employer/Protected Veterans/Individuals with Disabilities
The contractor will not discharge or in any other manner discriminate against employees or applicants because they have inquired about, discussed, or disclosed their own pay or the pay of another employee or applicant. However, employees who have access to the compensation information of other employees or applicants as a part of their essential job functions cannot disclose the pay of other employees or applicants to individuals who do not otherwise have access to compensation information, unless the disclosure is (a) in response to a formal complaint or charge, (b) in furtherance of an investigation, proceeding, hearing, or action, including an investigation conducted by the employer, or (c) consistent with the contractor's legal duty to furnish information. 41 CFR 60-1.35(c)