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Director, Medicare Enrollment at INTEGRA MLTC, INC.

Posted in General Business 30+ days ago.

This job brought to you by eQuest

Type: Full-Time
Location: Lake Success, New York

Job Description:

General Purpose/Scope:
The Director, Medicare Enrollment will be responsible for accurate and timely processing of Medicare enrollment applications and the complete Medicare Enrollment & Financial Reconciliation process. This position requires the individual to act as a liaison between the Enrollment Department and the Sales & Marketing team, Customer Service and Finance. The Director is responsible to finalize all applications while adhering to Medicare Enrollment guidance and regulatory requirements. The incumbent will work closely with the Medicare Business Lead, to ensure alignment with company's strategic outlook while developing best practices with respect to Medicare business practices. This position is responsible for the ability to understand and abide by Federal Centers for Medicare and Medicaid Services guidance.

Responsibilities include:

Accountable for the overall success of the Integra Medicare Enrollment department including accuracy of Integra Medicare membership and corresponding member premium payments
Ability to manage CMS and Internal Enrollment-based audits.
Daily coordination and collaboration with the Sales & Marketing Department ensuring timely receipt of completed Medicare Advantage enrollment applications
Daily coordination with the Customer Service department providing enrollment and eligibility support
Manage the end to end enrollment process including:

Processing Medicare applications within the Care Compass system while adhering to Medicare enrollment regulations
Ensuring Daily Transaction Reply Reports (DTRR) are processed within the Care Compass system
Generating and fulfillment of member enrollment correspondence while ensuring compliance and accuracy of various types of member correspondence

Reconciliation of daily, weekly and monthly CMS Medicare Enrollment reporting
Financial reconciliation of membership data, premium payments, special status reporting, and identification of potential over and under payments
Review and analysis of membership and premium reporting to dictate daily/weekly priorities
Reconciling eligibility discrepancies relying on your ability to arrive at a consistently compliant disposition after the analysis of information from several reference-guidance, Call Center notes, multiple databases, and telephone outreach
Identification and communication of processing performance opportunities
Provide overall leadership and accountability for the Medicare Advantage business line
Oversee and offer significant input into the annual Medicare application, bid and implementation efforts
Work directly with Senior Management to build the necessary organizational support and infrastructure to ensure operational success
Lead enrollment impacted system designs and operational procedures including best practices
Provides consultation to all internal areas regarding Medicare enrollment capabilities
Responsible for strategic and proactive hiring, performance management and coaching/mentoring/training to enhance professional development.
Responsible for development and updating of departmental policies and procedures


Bachelor's degree in business, health care administration, or related field required
Minimum 5 years of Medicare enrollment & management experience in a health care organization


Must be proficient with CMS enrollment and eligibility regulations with proven capability to execute compliance operationally
Must understand Risk Adjustment & CMS Special statuses and their impact on premium payment
Strong knowledge of and experience with Medicare program and regulations
Marketing experience in a health plan setting preferred
Excellent planning, organization, and analytical skills
Strong detail orientation and customer service skills
Proven record of success as a leader, including coaching and mentoring a team
Ability to work well under pressure in a complex and rapidly changing environment
Excellent verbal and written communications, presentation and interpersonal skills
Proficient with Microsoft (EXCEL, Word, PowerPoint)

Integra is an Equal Opportunity Employer and prohibits discrimination or harassment based on any characteristics protected by the laws or regulations in the locations where we operate.

If this opportunity sounds exciting and challenging to you, please click "Apply" now!