Job Description
Summary:
We are seeking a Service Delivery Leader (Director of Membership Reconciliation) with expertise in the Affordable Care Act (ACA) Marketplace and Exchange operations. The ideal candidate will have a deep understanding of enrollment, membership operations, and reconciliation processes, including but not limited to 834, 820, RCNO, RCNI, EAPS, HICS, and other CMS and state-specific files. This role requires strong leadership, analytical, and project management skills, and a track record of success in healthcare enrollment reconciliation.
Roles and responsibilities:
- Lead a team responsible for accurate and compliant reconciliation of enrollment and membership data for the ACA Marketplace and Exchange line of business.
- Oversee the reconciliation of 834 and 820 files, RCNO, RCNI, EAPS, HICS, and other relevant CMS files, using innovative solutions to enhance and automate processes.
- Collaborate with IT teams, Project Managers, and Business Partners to develop detailed Business Requirements based on analytic research and Root Cause Analysis.
- Provide leadership in developing metrics, continuous improvement efforts, and managing day-to-day operations related to financial reporting and analysis.
- Design and establish teams and processes for enrollment and payment/subsidy reconciliations with CMS, ensuring regular reporting to finance teams on outstanding accounts receivable and unprocessed cash.
- Utilize data analytics to identify process improvement opportunities and ensure accurate reporting of enrollment and payment/subsidy reconciliation.
- Lead a large team of 200+ individuals, ensuring efficient and effective reconciliation processes in a high-pressure, fast-paced environment.
- Implement change and drive process improvements and operational efficiencies within the reconciliation processes in a matrix environment.
- Collaborate with cross-functional teams and external stakeholders to ensure seamless coordination and communication.
- Drive strategic initiatives to improve reconciliation processes and ensure compliance with regulatory requirements, focusing on high-quality service delivery.
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Qualification:
- Bachelor's degree in a relevant field; an advanced degree is preferred.
- Extensive experience in healthcare enrollment reconciliation, specifically within the ACA Marketplace and Exchange line of business.
- Strong understanding of CMS files including 834, 820, RCNO, RCNI, EAPS, HICS, and other relevant reconciliation files.
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