Job Information
NASCO Manager, Enrollment, Maintenance & Billing and Services in Hartford, Connecticut
Overview
The Business Process Services (BPS) Manager is focused on the Enrollment, Membership, and Billing (EM&B) domain and responsible for overseeing department activities ensuring efficient, accurate, and compliant operational processing. They will provide direction and guidance to members of the team, partners, and vendor resources. The BPS Manager will lead by example, working complex scenarios and issues while supporting team activities. The BPS Manager will work with vendor resources to plan and execute day to day work activities and ensure adherence to training and guidelines. They will work with the vendor to ensure all service level agreements (SLAs) and metrics are met. The BPS Manager will generate and provide metrics and reporting to demonstrate the performance of the BPS work. The BPS Manager will report to the Director, communicating performance, risks and issues. When necessary this person will work with the Director to develop contingency plans and corrective action plans.
Note: We do not hire in the following states: AK, AR, DE, HI, ID, LA, ME, MN, MS, NV, NH, NM, ND, OR, RI, SD, VT, VA, WV, WY, D.C.
Responsibilities
Performs oversight of the enrollment, billing, and membership operations ensuring efficient and accurate processing enrollment, maintenance and billing according to CMS requirements and regulations
Liaison to Services team coordinating efficient and accurate member ad provider servicing as well as Grievance and Appeals processing according to CMS requirements and regulations.
Serves as the internal expert on CMS EM&B processing guidelines and regulations
Serves as the internal expert on CMS and BlueCross BlueShield Service processing guidelines and regulations
Establishes regular cadence to review and analyze vendor metrics to ensure requirements are met
Drives corrective action to address when any measures fall out of tolerance and metrics
Serves as a point of escalation for business process execution
Coordinates with vendors and customers to resolve issues
Coordinates reporting and communications within the organization’s compliance team or external compliance counterparts
Leads by example, works escalations and issues, as needed
Produces weekly snapshot of activities and adherence to compliance and raise awareness of anomalies with leadership
Leads and supports audit activities as necessary
Leads, influences and manages a team of resources to include conducting talent acquisition activities, coaching and/or mentoring, and identifying training requirements for associates
Conducts performance management activities, including performance reviews, goals, development, and continuous feedback
Creates, manages, and administers a departmental budget
Qualifications
Required Knowledge, Skills, and Abilities:
Knowledge of health insurance/health care/managed care environment preferred
Ability to build productive, collaborative relationships
Ability to manage vendors and partners
Excellent communications skills, both verbal and written, with the ability to communicate across all levels of the organization
Ability to escalate issues in a timely manner and provide leadership with appropriate recommendations for resolution
Ability to plan, organize, assign and report on work to meet commitments
Ability to develop, foster, and maintain customer and vendor relationships at all levels of an organization
Ability to handle self professionally and with decorum
Experience:
1 year of experience in a leadership role managing resources, as a team lead or manager
3 years EM&B operational experience
1 year call center experience
5 years managing operational metrics for timeliness and quality
Required Education:
- Bachelor’s degree or equivalent from a four-year college or university
Benefits and Perks:
Work/Life Balance – NASCO helps you find success at the workplace, and at home
Matching 401(k)
Employee Recognition and Bonus Programs – When NASCO is successful so are our employees!
Tuition Assistance – Learn, develop, and grow… on our dime!
E-Learning – Comprehensive and current library of e-learning and performance support assets, available on demand and at no cost
Choice of Blue Cross Blue Shield Medical, Dental and Vision Plans
Company-funded spending/reimbursement accounts to help with out-of-pocket medical expenses
Wellness Program
17 Days of Paid Time Off (PTO) per year – not including major holidays. That’s just starting out
Company discount plans on mobile, technology services, etc., to help you save money
NASCO is an Equal Opportunity Employer/veterans/disability/race/color/religion/sex/sexual orientation/gender identity/national origin. Must have legal authority to work in the US.
Location US-GA-Atlanta | US-Home Office/ Remote
# Positions 1
Category Management - Other Management
Travel Requirements 0-20%