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PacificSource is an equal opportunity employer.  All qualified applicants will receive consideration for employment without regard to status as a protected veteran or a qualified individual with a disability, or other protected status, such as race, religion, color, sex, sexual orientation, gender identity, national origin, genetic information or age. PacificSource values the diversity of our community, including those we hire and serve. We are committed to creating and fostering a work environment in which individual differences and diversity are appreciated, respected and responded to in ways that fully develop and utilize each person’s talents and strengths.

The Director of Enrollment and Billing provides leadership support, guidance, and direction for teams executing both Billing and Enrollment operational functions across the Medicare, Medicaid, Commercial, & Individual market segments. This role has accountability to ensure that members are enrolled timely, accurately, and efficiently to provide appropriate access to care and services. As well as ensuring that customer premium and billing transactions are conducted timely and accurately to enable continuity of services and account receivables. The Director of Enrollment and Billing develop strategies, implement process improvements, ensure compliance, and champion quality. The role includes evaluating performance, enhancing customer experience, and driving efficiency. The ideal candidate will identify improvement opportunities, implement solutions, coach team members, and achieve key metrics.

Essential Responsibilities:

Develop and implement the strategic vision for the enrollment and billing operations, aligning with overall company goals.Drive higher level of productivity and performance within the teams to meet financial and Key Performance Indicator (KPI) commitments, while ensuring compliance with both state and federal regulationsIdentify opportunities and deliver innovative solutions to business problems that reduce operating expenses and drive enhanced customer experiencesEnsure accuracy and timeliness of member eligibility data within core operating systems and out to third party vendor partnersEnsure accuracy and timeliness of customer billing transactions and reconciliationsOversee vendor partner performance, contractual obligations, and deliverablesImplement new initiatives and deliverables to support Sentara strategic prioritiesBuild collaborative working relationships with internal and external business partners in support of delivering the best overall end-to-end customer experienceLead the work of delivering precise group setup, renewal data, and enrollment processing to ensure the accuracy of benefits, eligibility, rates, and contract materials for members, employers, and agents.Lead the creation and enforcement of enrollment and billing policies, procedures, and standards to ensure consistency and quality, and alignment with state and federal regulations.Oversee to ensure all activities align with relevant federal, state, and local regulations, including Medicare and CMS requirements.Oversee the development and preparation of short-term and long-range plans for enrollment and billing teams and recommend policy changes to the Senior Leadership Team.Review investigation of group or member-level issues, assess their impacts, and escalate these matters to the appropriate departments and personnel for resolution.Ensure the availability of necessary resources and tools for effective delivery service.Responsible for oversight, management, development, implementation, and communication of department programs.Responsible for hiring, staff development, coaching, performance reviews, corrective actions, and termination of employees. Provide feedback, including regular one-on-ones and performance evaluations, for direct reports.Develop annual department budgets. Monitor spending versus the planned budgeted throughout the year and take corrective action where needed.Coordinate business activities by maintaining collaborative partnerships with key departments.Responsible for process improvement and working with other departments to improve interdepartmental processes. Utilize lean methodologies for continuous improvement. Utilize visual boards and daily huddles to monitor key performance indicators and identify improvement opportunities.Actively participate as a key team member in Manager/Supervisor meetings.Actively participate in various strategic and internal committees in order to disseminate information within the organization and represent company philosophy.

Supporting Responsibilities:

Meet department and company performance and attendance expectations.Follow the PacificSource privacy policy and HIPAA laws and regulations concerning confidentiality and security of protected health information.Perform other duties as assigned.

SUCCESS PROFILE

Work Experience: Minimum of seven (7) years of health insurance operations experience across multiple business segments (Medicaid, Medicare, Commercial, Individual), to include leadership experience with large scale teams and critical business functions. At least 3 years of experience working in enrollment, billing, and heavily regulated operating environment, preferably health care.

Education, Certificates, Licenses: Bachelor’s degree in Business or related field required or equivalent education and experience.

Knowledge: Deep understanding of health plan products, plan designs, provider relationships, and health insurance terminology. Knowledge of commercial, Medicaid and Medicare health plans. CMS, state-based and federally facilitated marketplaces, and state regulation strongly preferred. Basic understanding of claims processing system and operation. Consistently helpful, confident, and pleasant with all types of customers, both internal and external. Relationship skills and leadership qualifications. Ability to clearly communicate with co-workers and takes proactive, as well as responsive, action to ensure good service. Ability to read and understand health contract and benefits language. Ability to work under time pressures and deal with difficult situations. Ability to define and prioritize problems and manage workload without direct supervision. Ability to read and understand health contracts and benefit language.

Competencies

Authenticity

Building Organizational Talent

Coaching and Developing Others

Compelling Communication

Customer Focus

Empowerment/Delegation

Emotional Intelligence

Leading Change

Managing Conflict

Operational Decision Making

Passion for Results

Environment: Work inside in a general office setting with ergonomically configured equipment. Travel is required approximately 10% of the time.

Skills:

Accountable leadership, Business & financial acumen, Empowerment, Influential Communications, Situational Leadership, Strategic Planning

Our Values

We live and breathe our values. In fact, our culture is driven by these seven core values which guide us in how we do business:

We are committed to doing the right thing.We are one team working toward a common goal.We are each responsible for customer service.We practice open communication at all levels of the company to foster individual, team and company growth.We actively participate in efforts to improve our many communities-internally and externally.We actively work to advance social justice, equity, diversity and inclusion in our workplace, the healthcare system and community.We encourage creativity, innovation, and the pursuit of excellence.

Physical Requirements: Stoop and bend. Sit and/or stand for extended periods of time while performing core job functions. Repetitive motions to include typing, sorting and filing. Light lifting and carrying of files and business materials. Ability to read and comprehend both written and spoken English. Communicate clearly and effectively.

Disclaimer: This job description indicates the general nature and level of work performed by employees within this position and is subject to change. It is not designed to contain or be interpreted as a comprehensive list of all duties, responsibilities, and qualifications required of employees assigned to this position. Employment remains AT-WILL at all times.