Enrollment Reconciliation Program Director

1 week ago

Somerville, Massachusetts, United States Mass General Brigham Full time
Overview:
Mass General Brigham Health Plan is a dynamic leader in the healthcare sector.

As part of our organization, you will be at the forefront of innovation within one of the premier integrated healthcare systems globally.

We are dedicated to delivering innovative solutions tailored to our members' health requirements, enhancing access to comprehensive and affordable care.

Our mission focuses on crafting an outstanding member experience, a commitment that begins with our workforce.

Our team collaborates with some of the most skilled professionals in healthcare, providing opportunities for learning and sharing expertise in an environment that values diversity and inclusion.

We offer competitive compensation, a comprehensive benefits package with flexible work arrangements, opportunities for career advancement, and much more.

Key Responsibilities:

  • Ensure accurate reconciliation of all enrollment transactions.
  • Collaborate closely with IT to define requirements and user stories, and approve changes for production.
  • Lead initiatives to automate systems in Enrollment, aiming to reduce administrative costs and enhance member experience.
  • Empower and motivate staff; navigate change effectively and build consensus when necessary.
  • Identify and establish processes to meet key objectives, clearly defining accountability for important goals and deadlines.
  • Maintain accuracy in the internal reconciliation portal and troubleshoot QNXT-specific issues.
  • Document and address process gaps and improvements.
  • Manage reconciliation tools for all enrollment activities, including EDI file processing and online enrollments.
  • Oversee vendor extracts and error reports, ensuring proactive communication of identified issues.
  • Serve as the primary contact for data requests and audit responses within the Enrollment team.
  • Act as a resource and liaison for other departments and external clients in resolving operational issues.
  • Develop and uphold processes in line with regulatory guidelines from the DOI and AGO.
  • Drive corporate initiatives to enhance business processes and systems through collaboration.
  • Be the key eligibility contact for various vendors.
  • Work with IT to prioritize and approve team tickets.
  • Participate in project teams to provide insights on Enrollment processes.
  • Persistently pursue objectives, overcoming challenges to achieve results.
  • Build and maintain strong customer relationships, delivering solutions that meet expectations.
  • Hold oneself and others accountable for commitments.
  • Integrate diversity, equity, and inclusion as fundamental principles.
  • Foster relationships that position Mass General Brigham Health Plan as a people-first organization.
  • Perform other duties as assigned.

Qualifications:

  • BA/BS degree or equivalent experience, with a minimum of 5 years in a related field.
  • At least 5 years of experience in reconciliation.
  • Preferred 4+ years of staff management experience, ideally in a managed care setting.
  • Proficiency in SQL Server.
  • Skilled in MS Office Suite, including Power BI, PowerPoint, Excel, and Word.
  • Familiarity with QNXT and 834 EDI transactions.
  • Understanding of 820 transactions.
  • Strong problem-solving, leadership, and initiative skills.

Skills and Competencies:

  • Exemplify Mass General Brigham Health Plan's core values of listening, challenging norms, and delivering value.
  • Encourage innovative ideas by engaging with employees and stakeholders.
  • Treat all individuals fairly and equitably, respecting their unique contributions.
  • Proven ability to execute projects on time and within budget.
  • Strong aptitude for technology-driven solutions.
  • Ability to energize teams and drive results.
  • Stay informed on healthcare trends.
  • Demonstrate visionary thinking and the ability to foresee potential improvements.
  • Effectively communicate complex topics to diverse audiences.
  • Maintain a long-term perspective on industry trends and business cycles.
  • Apply strategic frameworks to analyze challenges and develop solutions.
  • Challenge the status quo and implement innovative strategies successfully.
  • Exhibit strong interpersonal skills, influencing stakeholders at all levels.
  • Display high emotional intelligence and self-awareness.
  • Uphold integrity in all professional interactions.

Job Field:
Professional/Managerial
Organization:
Mass General Brigham Health Plan
Schedule: Full-time
Shift: Day Job
Employee Status:
Regular

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