Overview

Provides oversight to the day to day operations of the enrollment, recertification and CDPAS staff. Ensures staff performance is consistent with VNSNY CHOICE Health Plans goals and policies. Promotes program growth and assists with the resolution of a variety of problems as necessary. Works under general supervision.

Responsibilities
Participates in the Implementation of strategic and tactical initiatives that support goals, address risk and compliance, and retain/enhance revenue.Identifies workflow opportunities for improvement; makes recommendations to improve standardization and/or improve process efficiencies across CHOICE, as appropriate. Plans, organizes and prioritizes daily departmental activities and ensures adequate/appropriate staff coverage.Collaborates with Membership & Eligibility Unit (MEU)  leadership to develop performance metrics around productivity and quality. Develops reports to monitor and measure staff operations and performance; provides feedback to management on performance, and coordinates the development of work improvement plans and disciplinary actions with management, when appropriate.Ensures compliance with Health Insurance Portability and Accountability Act (HIPAA) related policies in regards to operations within the MEU Department.Responds to internal and external inquiries and complaints; engages the necessary resources to ensure timely resolution. Ensures efficient follow-up and keeps management informed of status. Performs all duties inherent in a supervisory role. Ensures effective staff training, interviews candidates for employment, evaluates staff performance, and recommends hiring, promotions, salary actions and terminations, as appropriate.Participates in establishing productivity standards for agents and quality assurance programs for business operations.  Monitors agents productivity and develops action plans to address development opportunities as appropriate. Identifies and recommends opportunities for operational improvements.Participates in special projects and performs other duties as required.

For, Inbound & Outbound Enrollment:

Monitors incoming interval call volume throughout the day, and makes adjustments to staffing as needed, including re-assignment of staff, cross-skilling, and assisting answering consumer calls when deemed necessary by the leadership team.Ensures referrals from both inbound and outbound teams are inputted into the systems accurately and timely. Monitors staff’s monthly productivity ensuring that monthly goals are being met. Oversees scheduling of daily visits and supports rescheduling and re-assignments to vendors.

For, Enrollments-Administrative:

Works with government agencies, Local Department of Social Services (LDSS), Human Resources Administration (HRA) and Enrollment broker to identify and resolve issues that impede enrollment.  Obtains and disseminates timely Medicaid/Mandatory enrollment updates / local DSS requirements to the enrollment team as they become available.

For, Medicaid Operations:

Ensures that staff works closely with client, support system and/or family to obtain or recertify Medicaid. Connects client to appropriate MLTC in the community.Monitors incoming interval call volume throughout the day, and make adjustments to staffing as needed, including re-assignment of staff, cross-skilling, and assisting answering consumer calls when deemed necessary by the leadership team.

For, CDPAS Operations:

Assigns and monitors daily case load of expired or expiring MD orders of MLTC and MAP members. Triages incoming inquiries, both internal and external, to the CDPAS team as needed for follow-up. Tracks and monitors CDPAS mailing and team’s daily productivity to ensure monthly goals are achieved.

For, Placement and Disenrollment Operations:

Oversees administrative functions related to MLTC enrollment and disenrollment and works with program staff to facilitate enrollment and/or dis-enrollment of members, and resolves any issues and problems as they arise.  Reviews enrollment and disenrollment requests to ensure compliance to rules and regulations.  Monitors processes related to membership activity to ensure adherence to policy.Oversees Personal Care Assistant (PCA) placements for MLTC and  MAP members and manages the pending placement queue in HHAx and collaborates with Care Management and Authorization team to ensure PCA services are started timely
Qualifications

Education:Bachelor’s degree in Health Care Administration or related discipline, or the equivalent work experience required.

Experience:  Minimum of two years Medicaid and Medicare experience required.  Supervisory experience preferred. Knowledge of Medicaid and Health Care administration and terminology required. Proficient with personal computers, including Microsoft Windows: Word, Excel, Access, Salesforce required.  Effective verbal/written communication and interpersonal skills required.  Ability to multi-task in a fast-paced environment required.