Director, Enrollment Operations
New
J
JobgetherHealthcare
Remote work arrangement within the United States.Full-TimeDirector
SalaryBase salary range of $113,000–$197,700 USD annually.
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Job Details
- Experience
- 7+ years of leadership and management experience; 5+ years of business operations
- Required Skills
- Operations Management
Requirements
- Bachelor’s degree in accounting, finance, healthcare management, or related field.
- 7+ years of leadership and management experience.
- 5+ years of business operations experience, preferably within a healthcare environment.
- Required experience in Medicaid managed care, Medicare Advantage, or Dual Special Needs Plans (D-SNP).
- Demonstrated experience leading system integrations, mergers, acquisitions, or operational transformation.
- Deep knowledge of enrollment operations, CMS regulations, and healthcare operational workflows.
- Familiarity with systems such as TriZetto EAM, Facets, MARx, HPMS, and MMIS.
- Strong understanding of compliance, audit requirements, and internal controls.
- Proven ability to design oversight frameworks, reconciliation models, and dashboards.
- Advanced computer skills, including Microsoft Office.
Responsibilities
- Lead end-to-end enrollment operations across assigned markets, including prospective enrollment, auto-enrollment, disenrollment, reinstatement, and reconciliation.
- Develop and execute enrollment operations strategies aligned with product growth and regulatory requirements.
- Lead the integration of enrollment operations for newly acquired or merged health plans, including system alignment and data migration.
- Establish and manage an enterprise enrollment oversight framework incorporating reconciliation methodologies and executive reporting.
- Partner with IT to define system enhancements, data governance practices, and scalable technology solutions.
- Manage relationships with enrollment vendors, monitoring SLA performance and driving timely resolution of exceptions.
- Lead transformation initiatives involving automation, AI-enabled reconciliation, and process optimization.
- Maintain readiness for CMS, Medicaid, and state regulatory audits, including remediation activities.
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