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Enrollment Reconciliation Program Director

2 months 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 our team, you will be at the forefront of innovation, contributing to one of the premier integrated healthcare systems globally.

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

Our mission focuses on cultivating an outstanding member experience, a commitment that begins with our workforce. Collaborating with some of the most skilled professionals in the healthcare field, our employees have the chance to grow and share their expertise in an environment that values diversity and inclusion.

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

Key Responsibilities:
  • Ensure the accurate reconciliation of all enrollment transactions.
  • Collaborate closely with IT to define requirements and user stories, approve results, and endorse changes for production.
  • Lead initiatives to automate systems within Enrollment, aiming to lower administrative costs while enhancing member experience and operational efficiency.
  • Motivate and empower team members; navigate change and challenges effectively. Make informed decisions and foster consensus as needed.
  • Identify and establish processes, aligning resources to achieve critical objectives; clearly communicate accountability for key goals, timelines, and expectations.
  • Maintain accuracy in the internal reconciliation portal (MERP tool) and address QNXT-specific troubleshooting.
  • Document and address process gaps and improvements.
  • Oversee reconciliation tools for all enrollment activities, including EDI file loading, processing of pending/rejected transactions, and both paper and online enrollments.
  • Manage vendor extracts and error reports, ensuring proactive communication of 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 for other departments and external clients in resolving operational or transaction-related issues.
  • Develop and uphold processes in compliance with regulatory standards set by the DOI and Attorney General's Office (AGO).
  • Drive corporate initiatives to enhance business processes and systems through collaboration with other departments.
  • Be the key eligibility contact for Behavioral Health, Dental, Eye Med, ID Card, and Pharmacy vendors.
  • Work 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.
  • Build and maintain strong customer relationships, delivering solutions that meet expectations; establish effective relationships with both internal and external stakeholders.
  • Hold oneself and others accountable for meeting commitments.
  • Integrate diversity, equity, and inclusion as fundamental principles.
  • Foster a people-first culture within Mass General Brigham Health Plan.
  • Perform other duties as assigned, with or without accommodation.
Qualifications:
  • BA/BS degree or equivalent combination of education and experience, along with 5+ years of relevant experience.
  • Minimum of 5 years of experience in reconciliation.
  • Preferred 4+ years of experience in staff management, ideally within a managed care context.
  • Proficiency in SQL Server.
  • Strong skills in MS Office Suite, including Power BI, PowerPoint, Excel, and Word.
  • Familiarity with QNXT and 834 EDI transactions.
  • Understanding of 820 transactions.
  • Demonstrated problem-solving abilities, leadership, and initiative.
Skills and Competencies:
  • Exhibit Mass General Brigham Health Plan's core principles of active listening, challenging norms, and delivering value.
  • Encourage innovative ideas by engaging with employees and the communities we serve.
  • Value the unique contributions of every individual and ensure fair treatment for all.
  • Proven ability to execute projects on time, within budget, and scope.
  • Strong aptitude for technology-driven solutions.
  • Ability to energize teams and stakeholders when necessary.
  • Stay informed on current healthcare trends.
  • Demonstrate visionary thinking, recognizing both current realities and future possibilities.
  • Effectively communicate complex topics across various forums, adapting messages to suit different audiences.
  • Possess strong interpersonal skills, with the ability to influence at all organizational levels.
  • Exhibit high emotional intelligence, self-awareness, and receptiveness to feedback.
  • Maintain integrity in all professional interactions.
Job Field: Professional/Managerial
Organization: Mass General Brigham Health Plan
Schedule: Full-time
Shift: Day Job
Employee Status: Regular