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 organization within the healthcare sector.

As part of Mass General Brigham, we are at the forefront of innovation, collaborating within one of the premier integrated healthcare systems globally.

Our mission revolves around delivering cutting-edge solutions tailored to our members' health requirements, enhancing access to seamless and affordable care and coverage.

We prioritize creating an outstanding member experience, a commitment that begins with our workforce.

Our team comprises some of the most skilled professionals in healthcare, offering opportunities for learning and sharing expertise in an intentionally inclusive environment that celebrates diversity.

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

The Enrollment Reconciliation Program Manager will oversee the accuracy of all enrollment reconciliation activities, contributing to an enhanced member experience.

This role encompasses the forecasting, planning, evaluation, and implementation of all facets of enrollment reconciliation within QNXT.

Collaborating closely with internal stakeholders, including the IT department, the Enrollment Reconciliation Program Manager will focus on developing discrepancy reporting functionalities to optimize the enrollment department's operations.

This position will also lead all internal and external audit responses and ensure that vendor extracts are equipped with the necessary tools for reconciliation.

The ideal candidate will facilitate significant process improvements within the department to enhance efficiency.

Key Responsibilities:

  • Ensure accurate reconciliation of all 834 transactions.
  • Collaborate with IT to define requirements and user stories, and approve changes for production.
  • Lead initiatives to automate systems in Enrollment, reducing administrative costs and enhancing member experience and operational efficiency.
  • Empower and motivate staff; navigate change and challenges effectively. Make informed decisions and foster consensus as needed.
  • Identify and establish processes, aligning resources to achieve key objectives; communicate clear accountability for important goals, deadlines, and expectations.
  • Ensure accuracy in the internal reconciliation portal (MERP tool) and troubleshoot QNXT-specific issues.
  • Identify and document process gaps and opportunities for improvement.
  • Manage reconciliation tools for all enrollment activities, including EDI file loads, processing pending/rejected transactions, and both paper and online enrollments.
  • Oversee all vendor extracts and error reports, documenting processes and proactively communicating issues identified by the team.
  • Serve as the primary contact for data requests within the Enrollment team, including audit responses.
  • Act as a resource and liaison to other departments and external clients in resolving operational and transactional issues as necessary.
  • Develop and maintain specific processes in compliance with regulatory guidelines established by the DOI and Attorney General's Office (AGO).
  • Drive corporate initiatives to enhance business processes and systems through collaboration with other departments.
  • Act as the key eligibility contact for Behavioral Health, Dental, Eye Med, ID Card, and Pharmacy vendors.
  • Collaborate with IT to prioritize and approve tickets submitted by team members.
  • Participate in project teams to provide insights on Enrollment processes as needed.
  • Demonstrate persistence in achieving objectives despite challenges and setbacks.
  • Cultivate strong customer relationships and deliver solutions that meet expectations; maintain effective relationships with both internal and external customers.
  • Hold oneself and others accountable for meeting commitments.
  • Integrate diversity, equity, and inclusion as a core principle.
  • Persistently pursue objectives to achieve results despite any arising obstacles.
  • Build robust relationships and frameworks that position Mass General Brigham Health Plan as a people-first organization.
  • Perform other duties as assigned, with or without accommodation.

Qualifications:

  • BA/BS degree required or equivalent combination of training and experience, plus 5+ years of relevant experience.
  • 5+ years of experience in reconciliation required.
  • 4+ years of staff management experience preferred, ideally within a managed care setting.
  • Proficiency in SQL server.
  • Skilled in MS Office Suite, including Power BI, PowerPoint, Excel, and Word.
  • Understanding of QNXT and 834 EDI transactions.
  • Familiarity with 820 transactions.
  • Strong problem-solving, leadership, and independent initiative skills.

Skills/Abilities/Competencies:

  • Exemplify Mass General Brigham Health Plan's core brand principles of active listening, challenging norms, and delivering value.
  • Foster innovation by listening to and collaborating with employees and the communities we serve.
  • Value the unique contributions of every individual and treat all individuals fairly and equitably.
  • Proven ability to execute projects on time, within budget, and according to scope.
  • Strong aptitude for technology-driven solutions.
  • Ability to energize teams when needed.
  • Stay informed on current healthcare trends.
  • Demonstrated visionary thinking; ability to recognize current realities and envision future possibilities.
  • Capable of developing, advocating for, and gaining support for new ideas and approaches.
  • Excellent leadership skills with a strong track record.
  • Ability to communicate complex topics effectively across various forums, tailoring messages to suit the audience; strong executive presence and communication skills.
  • Ability to analyze long-term trends and cycles in the business and industry, maintaining a broad perspective.
  • Proficient in applying strategic frameworks to analyze challenges and guide solution development.
  • Ability to challenge existing practices and drive innovative thinking, successfully implementing strategies.
  • Exceptional interpersonal skills, with the ability to influence individuals at all organizational levels.
  • High emotional intelligence; self-aware and receptive to feedback, using self-discipline to adapt accordingly.
  • Unquestionable integrity.

Job Field:

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

Employee Status:
Regular

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