Role: Service Delivery Leader (Membership Reconciliation)
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.
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.
Proven leadership and project management skills, with the ability to develop teams and meet strategic objectives.
Proficiency in data analytics tools and techniques, including predictive analytics, data modeling, and revenue forecasting.
Experience in managing sensitive and confidential information, producing accurate reports, and presenting findings to executive leadership.
Excellent communication and collaboration skills, capable of working effectively with cross-functional teams and external stakeholders.
Demonstrated ability to lead and manage large teams in a high-pressure, fast-paced environment.
Demonstrated ability to effectuate change and drive process improvements in a matrix environment.