Eligibility and Enrollment Manager

1 week ago


Houston, Texas, United States Apex Health Solutions Full time
Job Summary

We are seeking a highly skilled Team Lead - Member Concierge Operations to join our team at Apex Health Solutions. As a key member of our organization, you will be responsible for leading the functional areas and staff responsible for eligibility and enrollment operations.

Key Responsibilities:
  • Operational Leadership: Manage the day-to-day operations of the eligibility and enrollment team, ensuring that all tasks and projects are completed efficiently and effectively.
  • Process Improvement: Develop and implement process improvements to enhance the quality and efficiency of our eligibility and enrollment operations.
  • Communication: Maintain open and effective communication with internal and external stakeholders, including enrollment production teams, to ensure that deadlines are met and quality checks are performed.
  • Audit and Compliance: Establish and maintain audit tools and procedures to ensure that our operations are in compliance with regulatory requirements.
  • Vendor Management: Monitor the performance of external vendors to ensure that they are meeting our quality and production standards.
  • Enrollment Operations: Manage daily enrollment and disenrollment operations related to beneficiaries in Medicare Advantage products and Commercial products.
  • Staff Development: Develop and train departmental staff to ensure that they have the necessary job competencies to meet performance and quality standards.
  • Policies and Procedures: Develop and maintain departmental policies and procedures to ensure that they are current and aligned with business needs.
Requirements:
  • Education: Bachelor's Degree in health care administration, business, or related field.
  • Regulatory Knowledge: Firm grasp of CMS regulations and requirements.
  • Experience: Experience with all aspects of Medicare enrollment.
  • Technical Skills: Proficient computer skills, specifically with Microsoft Office and Windows.
  • Analytical Skills: Proficient analytical and research abilities.
  • Soft Skills: Strong work ethic and a sense of responsibility to other team members and external stakeholders.
  • Adaptability: Adaptable and a quick learner, willing to change to meet shifting customer and business needs.
About Apex Health Solutions:

Apex Health Solutions powers payers and providers choosing to engage in value-based risk contracting. Our unique solutions create alignment between payers and providers, generating unparalleled value.

Combined with our experienced and successful industry leadership, our focal point remains on improvement inpatient quality, satisfaction, and overall cost of care.



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