MGR ENROLLMENT, PREM. RECON. & TPL ADMIN. Job in Philadelphia 19107, Pennsylvania US
We are proud to be an EEO/AA employer M/F/D/V. Minorities and women are encouraged to apply. We maintain a drug-free workplace and perform pre-employment substance abuse testing.
GENERAL DESCRIPTION:
Provides management and direction to the, Enrollment and Premium Reconciliation and Third Party Liability (TPL) units. Manages these units to ensure compliance with highly regulated eligibility, enrollment and payment entitlement procedures.
PRIMARY RESPONSIBILITIES:
• Develops tactical business plans to ensure unit’s business objectives and goals are successfully accomplished and service levels are met or exceeded.
• Maintains positive work environment that supports initiative and self-direction, optimizes the experience, skill and capacity of team members, and rewards for performance.
• Builds and maintains collaborative relationships with multiple internal units to develop policies and procedures that ensure accurate and appropriate collection of member eligibility information to accomplish business objectives.
• Works with IS staff and vendors to identify and implement technology solutions to ensure compliance with regulatory, contractual and business performance management standards.
• Oversees electronic information transfer and system processes to capture other coverage resources and provides instruction to information services (IS) and third party claim administrators on use of same.
• Ensures implementation and maintenance of policies and procedures in accordance with statutory and regulatory requirements and ensures compliance to satisfy audits or probes by internal or external entities.
• Manages service operations performance and analysis of deficiencies, and initiates implementation of business process improvement or corrective action plans or +to increase overall efficiencies and improve customer satisfaction.
• Perform other duties as assigned.
KEY REQUIREMENTS:
Bachelors Degree preferred and 3-5 years experience in managed care and/or indemnity insurance with a minimum of 2 years in a management position. Experience in Medicare and/or Medicare enrollment and TPL processes preferred.
SKILLS/ABILITIES:
Excellent analysis and decision making skills. Strong mathematical aptitude and problem solving skills. Experienced in developing and managing cross-functional teams. Project management experience, preferred. Excellent organizational and time management skills. Excellent verbal and written communication skills. Strong interpersonal skills including influencing, negotiating, and conflict resolution. Working knowledge of PC based applications.
analytical and problem solving skills
