Enrollment Lead (hybrid remote)

Job Number: 5116

Workplace Type: Office Full-Time

Position Title: Enrollment Lead

External Description:

• The Enrollment Lead is responsible for the daily operations of the Enrollment Department. Oversees the team including monitoring of data files and generating department reports. Review of TRR’s, monthly audits internal and external. As well as maintaining the Centers of Medicare and Medicaid Services (CMS) timeliness, quality standards, policies, and procedures.

  Required Skills & Experience: 

  • Defines, and monitors performance and productivity standards specific to those systems that must be in place to serve AHP/AHC enrolled population.
  • Responsible and accountable for the training, and overall performance of the Enrollment staff to ensure that all qualitative and quantitative goals and objectives are met within the department.
  • Responsible for meeting the regulatory compliance in all areas that affect the Enrollment Department
  • Ensures daily TRR is validated and all transactions are reviewed.
  • Responsible for ensuring regulatory compliance in all areas that affect the Enrollment Team.
  • Problem-solving process to resolve and/or mitigate those operational issues resulting in negative performance to plan as determined by the established escalation process.
  • Will assist with creating department policies and procedures as needed to ensure the department is in accordance with CMS guidelines.
  • Development and implementation of programs with direct effect towards the Enrollment Team.
  • Ensure all files are maintained in the shared drive.
  • Submit monthly productivity reports to AVP.
  • Works with I.T department to create and implement systems to improve workflows, tracking, reporting, and maintenance.
  • Assists with monitoring staff attendance and performance.
  • Performs other duties as assigned.
  • High school diploma required; BA preferred
  • 2-5 years in a Health Maintenance Organization HMO or Medicare Advantage Prescription Drug Plan( MA-PD) preferred
  • Must be familiar with CMS MMR and TRR files
  • Chapter 2 Manage Care
  • Education/Licensure:
  • Bachelor’s degree or 5 years’ experience in related field

  Pay Range: Pay Rate: $43,300.00 - $64,900.00 Annually

  ield

City: Orange

State: California

Location City: Orange

Location State: California

Community / Marketing Title: Enrollment Lead (hybrid remote)

Company Profile:

Alignment Health is revolutionizing health care for seniors by leveraging our world-class technology platform, innovative care delivery models, deep physician partnerships and our serving heart culture! From member experience professionals and clinicians, to data scientists and operations leaders, we have built a talented and passionate team that is deeply committed to our mission of transforming health care for the seniors we serve. Ready to join us?

At Alignment Alignment, delivering exceptional care to seniors starts with ensuring an exceptional experience for our over 1,300 employees. At the center of our employee experience is a culture where employees at all levels and across all teams are encouraged to share their unique ideas and perspectives. After all, when you can bring your authentic self to work, whether that’s in a clinical setting, our corporate office or a home office, creativity and innovation flourish! Another important part of the Alignment culture is a belief in continuous learning and growth. As a result, in this fast-growing company, you will find ample support to grow your skills and your career – with us.

EEO Employer Verbiage:

 Please note: All clinical positions are contingent upon successful engagement with Alignment Health’s COVID-19 Vaccination program (fully vaccinated with documented proof or approved exception/deferral).

Alignment Health is an Equal Opportunity/Affirmative Action Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability, age, protected veteran status, gender identity, or sexual orientation.

*DISCLAIMER: Please beware of recruitment phishing scams affecting Alignment Health and other employers where individuals receive fraudulent employment-related offers in exchange for money or other sensitive personal information. Please be advised that Alignment Health and its subsidiaries will never ask you for a credit card, send you a check, or ask you for any type of payment as part of consideration for employment with our company. If you feel that you have been the victim of a scam such as this, please report the incident to the Federal Trade Commission at https://reportfraud.ftc.gov/#/. If you would like to verify the legitimacy of an email sent by or on behalf of Alignment Health’s talent acquisition team, please email [email protected].