Position Summary: Apex Health Solutions is expanding our services by building a member concierge team to assist our client’s health plan members with onboarding processes and questions. This position will be one of the initial points of contact with our client organization membership and shall provide initial onboarding through a disciplined flow of call scripting. Individuals within this team will also be responsible for ongoing outreach on a predetermined cadence to enrich the overall member experience. Essential Duties and Responsibilities: Manages the functional areas and staff that perform eligibility and enrollment operations. Develops and maintains proper controls to ensure inbound and outbound data and documents are processed within expected performance standards. Maintains communication with all internal and external enrollment production teams to ensure deadlines are met and quality checks are performed. Maintains quality assurance program and manages a quality assurance enrollment specialist to monitor in- and outbound billing and eligibility file accuracy, including but not limited to 834, Coordination of Benefits, invoice, and pharmacy eligibility files. Establishes audit tools and procedures to provide necessary quality assurance for functional areas; monitors expenses in full compliance with established budgets and policies. Monitors operations and performance of external vendors to ensure accuracy and production standards as well as regulatory requirements are met; reviews all pertinent vendors as part of creating consistent Scorecards and initiating Quarterly Reviews. Manages daily enrollment and disenrollment operations related to beneficiaries in Medicare Advantage products including receipt, tracking, reviews and processing of applications, all required submissions to CMS, and obtaining missing information and initiating any necessary corrections to CMS or Retroactive Processing Contractor (RPC). Manages daily enrollment/eligibility and disenrollment operations related to Commercial products including receipt, tracking, reviews and processing of applications within required timelines including obtaining missing information and initiating any corrections with employer groups as necessary. Oversees the assistance to individuals and families in navigating and/or enrolling in programs and services through in-person visits and follow-up communication and the provision to members of basic health insurance information such as access to care and enrollment in other program such as, Medicaid, LIS (Low Income Subsidy), or other products as appropriate. Develops and trains departmental staff through coordination of training materials and presenting in- services to ensure that employees have the job competencies necessary to meet performance and quality standards in their current roles and to enhance their future growth and potential; motivates subordinates, establishes teamwork, and builds employee morale. Develops and maintains departmental policies and procedures and desktop procedures according to current business needs as well as industry and regulatory requirements; ensures appropriate and effective departmental goals and objectives are developed, implemented, and monitored in accordance with company standards and operational and regulatory requirements. Communicates, collaborates, and cooperates with internal and external stakeholders in a respectful and responsible manner to enhance relationships and render exceptional service. Adheres to all Compliance/Program Integrity requirements. Complies with HIPAA Regulations. Promotes individual professional growth and development by meeting requirements for mandatory/continuing education and skills competency; supports department-based goals which contribute to the success of the organization; serves as preceptor, mentor and resource to less experienced staff. Qualifications/Education: Bachelor’s Degree is required; Bachelor’s Degree in health care administration, business or related field is preferred Ability to work from home with appropriate internet access and a quiet and private workspace. Firm grasp of CMS regulations and requirements; experience with all aspects of Medicare enrollment Conversant with benefit plan designs and plan structures such as utilization counters and their relation to eligibility; good understanding of provider network arrangements and their relation to eligibility Ability to multitask in a fast-paced environment. Proficient computer skills, specifically with Microsoft Office and Windows. Proficient analytical and research abilities. A desire to serve others while being empathetic with the drive to go above and beyond to help resolve questions at the first point of contact. Must have a strong work ethic and a sense of responsibility to other team members and external stakeholders to meet all needs represented by a robust sense of accountability Adaptable and a quick learner, willing to change to meet shifting customer and business needs. Excellent verbal and written communication skills Extremely organized and detail oriented. The ability to develop effective working relationships, and work collaboratively with all levels of staff, vendors, and partners. The above job description is not intended to be an all-inclusive list of duties and standards of the position. Incumbents will follow any other instructions, and perform any other related duties, as assigned by their supervisor. About Apex Health Solutions Apex Health Solutions powers payers and providers choosing to engage in value-based risk contracting. Apex’s unique solutions create alignment between payers and providers, generating unparalleled value. Combined with Apex’s experienced and successful industry leadership, our focal point remains on improvement inpatient quality, satisfaction, and overall cost of care.