Senior Enrollment Strategy Lead

Brightree is a wholly owned subsidiary of ResMed (NYSE: RMD, ASX: RMD).

When you work at Brightree, it’s more than just a job. You’ll be part of a team that’s driving innovation and leading the way in cloud-based patient management software. 

The technology allows us to provide the tools for better outcomes but at our heart, we’re really about people. We strive to positively impact our customers’ businesses and the lives of patients every single day.

The Enrollment Lead is responsible for the enrollment process for insurance payers with multiple clearinghouses and optimizing the efficiency of enrollment operations. This role involves collaborating with internal teams and vendor partners and leading initiatives to enhance enrollment strategies.

The Enrollment Lead is a subject matter expert on the payer enrollment processes and requirements for commercial insurance companies, CMS Federal and State Guidelines related to enrollment and re-enrollment policies. It is a hands-on, working Lead role.

Let’s talk about Responsibilities

Enrollment Management

• Lead the payer enrollment process, ensuring timely and accurate submissions of applications and required documentation.
• Communicate with healthcare providers to gather necessary documentation and information for enrollment or re-enrollment processes.
• Process incoming Enrollment requests for Commercial/Government insurance plans for new and existing clients serving as liaison between the client and the clearinghouse.
• Coordinate with clearinghouses to resolve any issues or discrepancies that arise during the enrollment process.

Process Improvement

• Identify and implement best practices to streamline enrollment processes with multiple clearing houses and reduce turnaround times.

Data Analysis

• Analyze enrollment data to identify trends, challenges, and opportunities and inform decision-making.

Stakeholder Collaboration

• Work closely with internal teams and external stakeholders (e.g., payers) to resolve issues and improve enrollment outcomes.

Documentation Maintenance

• Ensure accurate maintenance of enrollment documentation.

Case Management

• Complete deactivations of provider numbers, effective dates, NPI-related denials, NPI website, etc.
• Manage and complete product/service activation requests by following configuration steps and setting appropriate feature settings in the Brightree operating system.
• Respond to customer requests regarding system setup and activations.
• Accurately document interactions with customers and vendors in Salesforce following standard processes.
• Follow departmental procedures for case tracking and system updates.
• Process customer and internal escalations per department guidelines.

Team Leadership

• Advise enrollment staff, providing training and guidance on enrollment processes.
• Provide training and support on the enrollment process, documentation requirements, and the use of the enrollment portals.
• Be the subject matter expert for the team for best practices, process and workflow definition, and documentation creation and maintenance related to enrolling with multiple clearinghouses.

Let’s talk about Qualifications and Experience

• Bachelor’s degree in healthcare administration, business, or a related field.
• 3+ years of experience in payer enrollment, healthcare claims, commercial payers, and clearinghouse applications.
• Strong understanding of payer policies, enrollment processes, and compliance regulations.
• Excellent leadership and communication skills.
• Strong analytical and problem-solving skills.
• Detail-oriented with exceptional organizational abilities.
• Experience with electronic enrollment systems and healthcare IT solutions.
• Knowledge of healthcare reimbursement models and industry trends.
• Expert knowledge of electronic insurance setups and processes.
• Knowledge of accounts receivable and revenue cycle management.
• Ability to work independently and make sound and timely decisions.
• Excellent organizational, planning, and prioritization skills.
• Demonstrated ability to consistently follow documented processes or task workflows.
• Demonstrated ability to manage detailed tasks with accuracy and completeness.
• Ability to multi-task and manage ongoing task priorities.
• Advanced proficiency with Microsoft Office Suite Products.
• Experience using a CRM software solution (Salesforce).
• Experience with HME/DME software and providing customer service.

We are shaping the future at ResMed, and we recognize the need to