DIRECTOR OF ENROLLMENT OPERATIONS

JOB PURPOSE:

The Director of Enrollment Operations will oversee and manage the Data Entry, Eligibility and Enrollment, Clinical Assessments Operations, and Disenrollment functions, including staffing, operations and planning, monitoring, and performance improvement. This position will develop efficient and effective systems to ensure quality care and compliance with state, federal, PACE, and organizational regulatory requirements. This person will serve as a role model to staff with respect to ethical conduct, decision-making, and responsibility for high-quality customer service to participants, caregivers, prospects, referral sources, and other stakeholders.

JOB RESPONSIBILITIES:

• Oversee and ensure compliance with daily operations of the Data Entry, Intake, Eligibility, Enrollment, Clinical Assessments, Quality Reviewers, CDPAS, and Disenrollment functions.
• Improve workflows from referrals to enrollment submission while ensuring compliance with applicable guidelines.  
• Enhance data warehouse, manage data entry workflows, and monitor document oversight.  
• Ensure high performance and productivity of pre-enrollment verifications of Medicare, Medicaid, and PACE eligibility.
• Participate in all aspects of human resources management to ensure appropriate staffing, orientation, support, discipline, and timely performance appraisals. 
• Meet regularly with direct reports to review goals, trends, and performance measures and to facilitate needed changes and areas of improvement.
• Interview, hire, train, supervise, progressively discipline, and counsel all staff in the department.
• Develop workflows, processes, and job functions to meet enrollment and business goals. 
• Plan, develop, update, and implement policies and procedures and standard operating procedures.
• Ensure staff complies with state & federal laws regarding Medicaid and Medicare Eligibility and regulations.
• Budget adequate staffing and coverage plans given current and projected levels of enrollment.
• Ensure eligibility processes and systems are updated to reflect government programs and requirements changes.
• Oversee the clinical assessment and reassessment operation processes, including managing nurses’ schedules to ensure maximum conversion from referral to enrollment and timely reassessments as per department and business goals while remaining in compliance with CMS, NYSDOH, and PACE regulations.
• Identify referral trends that will lead to the conversion of appropriate PACE candidates into the program and improve the overall quality of enrollments.
• Monitor training of clinical staff on assessment visits, UAS-NY, PCAT, assessment tools, and capturing quality measures.
• In conjunction with the Care Delivery Department, oversee the authorization of personal care hours to ensure appropriateness and consistency with the participant's identified needs and Medicaid regulations.  
• Collaborate with Care Delivery leadership and other Care Delivery team members and provide meaningful information in advance of enrollment to ensure smooth transition and retention. 
• Ensure the disenrollment process and ensure that all disenrollment requests are processed timely and in accordance with all applicable department, CMS, NYSDOH, and PACE regulations.
• Manage retention initiatives to ensure high-quality customer service while staying in compliance.
• Collaborate with the Finance Department on surplus-related issues.
• Compile statistical data and reports.
• Maintain and generate required reports, including but not limited to NYSDOH, CMS, and Quality Improvement. 
• Analyze department productivity and identifies areas for improvement.
• Engage in continuous quality improvement programs to promote optimal staff performance and participant outcomes.
• Promote CenterLight Healthcare’s initiatives and projects.
• Assure delivery of quality services in accordance with organizational standards.
• Provide excellent customer service and communication with referral sources and departments. 
• Act as a Liaison between Entitlement Unit, Maximus, DOH, and LDSS as required. 
• Provide guidance on improving staff accountability and productivity.
• Manage relationships with contracted agencies and ensure invoices are processed accurately and timely. This function includes general oversight of day-to-day operations. 
• Engage in staff development and training materials for staff’s continuing education.
• Remain responsive and available by phone/email for contact by CenterLight staff.
• Lead weekly/monthly staff meetings within the departments to optimize productivity within the Unit.
• Participate in quality improvement projects.
• Monitor and oversee all department software