Manager Enrollment and Billing

Description and Requirements

We are seeking a detail-oriented and strategic Manager, Enrollment & Billing, to oversee the enrollment and billing processes, ensuring efficiency, accuracy, and compliance with company policies and regulatory requirements. This role will lead a team responsible for member enrollment, eligibility verification, premium billing, and reconciliation while driving process improvements and excellent customer service.

Duties and Responsibilities:

• Oversee the enrollment process, ensuring timely and accurate processing of new and modified enrollments, renewals, and terminations.
• Collaborate with internal teams (e.g., sales, customer service, compliance) to ensure seamless management of members.
• Monitor ,report, and deliver updates on memberships, data integrity and address discrepancies related to member eligibility and enrollment.
• Manage premium billing cycles, invoice generation, and payment reconciliation.
• Ensure timely processing of payments and address billing discrepancies or disputes.
• Evaluate the design and effectiveness of controls to ensures core Enrollment and Billing activities are managed in compliance with State and CMS guidelines and to ensure member satisfaction
• Lead cross functional risk assessment root cause analysis activities to identify, assess and address key risks within the operational area including the identification of business processes that do not have the measurements required to assess the health of the operations.
• Partner with Process Managers and Process Leads to assess, evaluate, and promote compliance to internal policies
• Work with finance teams to reconcile accounts and maintain accurate financial records.
• Supervise and develop a team of enrollment and billing professionals, setting performance goals and providing coaching.
• Identify opportunities to enhance processes, streamline workflows, and leverage automation for efficiency.
• Ensure compliance with regulatory guidelines and company policies.
• Act as a key point of contact for escalated enrollment and billing issues.
• Develop and implement strategies to enhance customer experience and satisfaction.
• Maintain effective communication with clients, brokers, and internal stakeholders.

• Bachelor's degree from an accredited institution or relevant work experience
• HS Diploma or GED from an accredited institution
• Leadership experience in a high-volume production billing, enrollment, claims, call center environment or related environment.
• Basic understanding of Agile methodology for software development at least from the role of a business stakeholder.
• Working knowledge of how data processes through systems and system integrations work to understand and plan for addressing failure points.
• Experience in inventory management
• Advanced proficiency in Microsoft Excel and PowerPoint and experience using at least one data visualization tool like Tableau.
• Proven ability to identify, optimize and streamline business processes to improve turnaround time and to reduce admin cost.
• Background in developing recovery plans to address a disruption to operations.
• Strong communication and presentation skills through all levels.
• Must demonstrate ability to understand and implement internal control concepts and perform root cause analysis to solve complex problems.
• Technical and data management skills including ability to identify, obtain, format, model, manipulate, and analyze large amounts of data and compile detailed reports / dashboards
• Proficiency in relevant software and systems (e.g., CRM, billing platforms, Excel).

• Hands on experience in designing solutions using data visualization tools like Tableau and Knowledge of NY lines of business such as Medicare NY, Medicaid, Child Health Plus, QHP, EP, HARP
• Bachelor's degree in Accounting, Finance, or Business Administration from an accredited institution preferred.
• Certification in claims processing or related area (e.g., CPC, AIC)