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Director, Enrollment & Payment-Senior Products

Point32Health

Who We Are

Point32Health is a leading health and wellbeing organization, delivering an ever-better personalized health care experience to everyone in our communities. At Point32Health, we are building on the quality, nonprofit heritage of our founding organizations, Tufts Health Plan and Harvard Pilgrim Health Care, where we leverage our experience and expertise to help people find their version of healthier living through a broad range of health plans and tools that make navigating health and wellbeing easier.

We enjoy the important work we do every day in service to our members, partners, colleagues and communities. To learn more about who we are at Point32Health, click here.

Job Summary

The Director, Enrollment & Payment-Senior Products is a shared services role that provides leadership, accountability, and management to several key business functions. Under your leadership, the department is responsible for the timely and accurate processing and reconciliation of enrollment transactions, eligibility reconciliations, premium payment reconciliations, as well as capitation payments to proivders, across multiple states. This role sets the strategic direction for the department in collaboration with operations and divisional leadership and serves as a key resource for corporate level strategic initiatives, including options analysis, risk identification, and resource and cost planning that will minimize administrative costs while promoting high quality. In support of all these business functions, the Director will efficiently manage the budget, facilitate effective systems and policies, continuously manage administrative cost reduction programs, and seek shared service efficiencies to maintain a low cost of operations.

Key Responsibilities/Duties – what you will be doing

  • Leads the department in establishing its strategic direction and leads in the identification, organization and implementation of key projects in collaboration with other departments within Point32Heatlh, internal staff and external parties
  • Lead the overall department budget process ensuring ongoing administrative cost reduction programs are in place
  • Participate in CMS Program Audit and 1/3 Financial Audit as applicable
  • Ensure the ongoing processing of enrollment transactions through multiple channels while continuously optimizing automation to ensure accuracy and appropriate staffing levels
  • Ensure financial and administrative controls are in place for all financial transactions including ensuring that the monthly premium reconciliation process is accurate and timely
  • Ensure compliance with all federal and state regulatory requirements
  • Hire, manage, develop and evaluate direct reports and properly assign work and oversee staff. Engage in ongoing staff development (e.g. leadership, training, technical skills, and managed care training) and adjust staffing needs to ensure appropriate staffing levels and skill sets required to effectively support the department’s needs
  • Monitor department performance against goals and targets to ensure timeliness, accuracy, adherence to metrics and take action to address gaps, missed targets and inventory builds using all available resources and making adjustments as necessary
  • Ensure oversight to the following processes, Late Enrollment Penalty (LEP), Out of Area (OOA), Enrollments, Disenrollments, Redeterminations, and Low Income Subsidy (LIS)
  • Lead continuous improvement through the review of trend reports to assess the performance of each key function. Analyze trends, identify issues and recommend and implement corrective actions as may be needed. Develop new management reports as may be needed to ensure the proper functioning of all processes
  • Continuously evaluate system capabilities to meet business needs and facilitate enhancements.
  • Engage in Vendor management activities that ensure appropriate service, quality and cost
  • Other duties as assigned

Qualifications – what you need to perform the job

  • Bachelor’s degree required, Master’s preferred
  • 10 or more years in an Operational leadership position ideally with experience in enrollment, revenue management, implementation of enrollment and revenue management systems and processes
  • Healthcare, Managed Care, Group Benefits, or insurance industry experience is preferred but not required
  • A track record that demonstrates success leading process improvement, system implementations, technology enablement, and leading change from a business owner perspective
  • Able to provide thought leadership in resolving complex problems including the development of new processes, controls, and systems
  • Highly visible position requires constant interaction and diplomacy with all levels of the company
  • Able to align operations with company strategy, programs, and values to ensure high levels of execution and program implementation
  • Requires a high level of analytical ability, initiative, and judgment necessary to bring timely resolution to regulatory, financial, and other sensitive issues
  • Comfortable working in a matrixed environment and able to resolve conflict in a diplomatic, direct, and timely manner
  • Extensive involvement with all levels of the company, as well as external customers, healthcare officials, and regulatory agencies
  • Must be able to interact and collaborate effectively with a broad range of internal and external stakeholders and leadership
  • Experience with Market Prominence preferred

Compensation & Total Rewards Overview

As part of our comprehensive total rewards program, colleagues are also eligible for variable pay. Eligibility for any bonus, commission, benefits, or any other form of compensation and benefits remains in the Company's sole discretion and may be modified at the Company’s sole discretion, consistent with the law.

Point32Health offers their Colleagues a competitive and comprehensive total rewards package which currently includes:

  • Medical, dental and vision coverage
  • Retirement plans
  • Paid time off
  • Employer-paid life and disability insurance with additional buy-up coverage options
  • Tuition program
  • Well-being benefits
  • Full suite of benefits to support career development, individual & family health, and financial health

For more details on our total rewards programs, visit https://www.point32health.org/careers/benefits/

Commitment to Diversity, Equity, Inclusion, Accessibility (DEIA) and Health Equity

Point32Health is committed to making diversity, equity, inclusion, accessibility and health equity part of everything we do—from product design to the workforce driving that innovation. Our Diversity, Equity, Inclusion, Accessibility (DEIA) and Health Equity team's strategy is deeply connected to our core values and will evolve as the changing nature of work shifts. Programming, events, and an inclusion infrastructure play a role in how we spread cultural awareness, train people leaders on engaging with their teams and provide parameters on how to recruit and retain talented and dynamic talent. We welcome all applicants and qualified individuals, who will receive consideration for employment without regard to race, color, religion, gender, gender identity or expression, sexual orientation, national origin, genetics, disability, age, or veteran status.

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Confirmed 8 hours ago. Posted 13 days ago.

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