Program Manager, Medicare D-SNP Enrollment

The pay range above represents the minimum and maximum rate for this position in California. Factors that may be used to determine where newly hired employees will be placed in the pay range include the employee specific skills and qualifications, relevant years of experience and comparison to other employees already in this role. Most often, a newly hired employee will be placed below the midpoint of the range. Salary range will vary for remote positions outside of California and future increases will be based on the pay band for the city and state you reside in.

Work Culture:

GCHP strives to create an inclusive, highly collaborative work culture where our people are empowered to grow and thrive.  This philosophy enables us to create the health plan of the future and do our best work – Together.

GCHP promotes a flexible work environment. Employees may work from a home location or in the GCHP office for all or part of their regular workweek (see disclaimer).

GCHP’s focuses on 5 Core Values in the workplace:

•    Integrity

•    Accountability

•    Collaboration

•    Trust 

•    Respect

Disclaimers:

•    Flexible work schedule is based on job duties, department, organization, or business need.

•    Gold Coast Health Plan will not sponsor applicants for work visas.

POSITION SUMMARY

The Program Manager, Medicare D-SNP Enrollment is responsible for enrollment activities to provide excellent service to potential and existing Duals Special Needs Plan (D-SNP) members and achieve enrollment goals. 

•    Ensure the accurate, timely processing and data entry of Medicare enrollments into the GCHP D-SNP, re-enrollments and disenrollment, subsequent maintenance of the enrollment data, compliance with regulatory requirements relating to enrollments and disenrollment, filing of applications, prospect and member communication, and other related documents. 

•    Address a variety of enrollment questions or concerns received via claims, call tracking, or email. 

•    Maintain all records in the enrollment database. 

Reasonable Accommodations Statement

To accomplish this job successfully, an individual must be able to perform, with or without reasonable accommodation, each essential function satisfactorily. Reasonable accommodations may be made to help enable qualified individuals with disabilities to perform the essential functions.

ESSENTIAL FUNCTIONS

Job Function & Responsibilities

•    Responsible for preparation, timely processing of enrollment applications, management, and maintenance in accordance with CMS and DHCS regulations. Ensures compliance with all applicable policies, processes, and procedures.

•    Oversees the enrollment activities and reconciliation.

•    Strong knowledge of the Enrollment process along with State, Federal, and business regulatory requirements and other state specific applications concerning Medicare Enrollment.

•    Ensure quality control of data entered into membership data base and sent to external vendors.

•    Oversees and participates in state, federal, and internal audits, as needed.

•    Responsible for the accurate and timely dissemination of eligibility data to the network, ancillary providers, and internal systems.

•    Ensures staff is complaint with regulatory and company guidelines, including HIPAA compliance.

•    Partners with the Chief, Member Experience to establish departmental goals and objectives that support our mission and goals and ensure that individual performance goals support departmental goals. 

•    Partners with Chief Member Experience and External Affairs Officer to develop performance competencies and metrics that are meaningful and measurable and aligned with our business goals and objectives. Ensures that agreed-upon performance competencies and metrics are meaningful and measurable; implemented timely; communicated and understood by the staff; and metrics are consistently met or exceeded.

•    Oversee and manage the auditing of enrollment and disenrollment information data and certify its completion and accuracy.

•    Develop, create, and implement policies and procedures, workflows and job aides as required to provide training for the Medicare Enrollment department.

•    Responsible for ensuring timely reconciliation of eligibility files and adjustments to CMS that meet regulatory and health plan requirements, as required.

•    Coordinate and manage the generation and mailing of all necessary