Lead Enrollment Coordinator has the primary responsibility of supervising the enrollment reconciliation team to ensure enrollment and premium reconciliation processes are completed timely and accurately each month as a condition of participation in the Federally Facilitated Marketplace (FFM) Individual Market product. Experienced with CMS regulations and guidance. Interprets guidance and translates into departmental policies and procedures to support reconciliation activities. Acts as a subject matter expert and has extensive knowledge of individual market enrollment process through the FFM and direct enrollments and understands the premium billing and payment collection process.Responsible for compliance with data integrity and annual payment attestation requirements. Interacts with various internal departments: Individual Market Operations Enrollment and Premium teams and external departments including Information Services, EDI and Customer Service. Liaison between reconciliation vendor to ensure successful receipt and processing of reconciliation files and disputes. Monitors work inventories. Creates monthly statistics for management. Acts as Intermediary between CMS reconciliation team and Priority Health reconciliation team.Must demonstrate analytical/problem solving skills and be able to comprehend the interconnected relationships with multiple processes and systems. Ability to communicate clearly and concisely with team and managers. Essential FunctionsCoordinates with Information Services to review, monitor and troubleshoot issues with the creation of the inbound reconciliation file (RCNI) Ensures the RCNI file is submitted timely to CMS each month and tracks compliance Analyzes technical guidelines for both inbound and outbound reconciliation files and determines necessary corrections to assure compliance with regulations Manages outbound reconciliation file (RCNO) process that identifies mismatches between Priority Health and CMS data Works with Reconciliation vendor to load RCNO data accurately and provide reports for reconciliation team to review Validates identified discrepancies are either corrected in the source system (Facets) or disputed with CMS Reviews and tracks all dispute responses and conducts follow up on outstanding issues Conducts root cause analysis on high volume errors and proposes and develops solutions Interacts with CMS Account Managers on reconciliation and other CMS data issues Develops and maintains statistics on reconciliation errors Monitors staff to meet designated performance metrics Coordinates annual payment attestation review Documents processes and procedures as applicable Managing all CMS reports and development of actions required Monitor the pre-audit files received from CMS for missing enrollments Educates team on data reconciliation process Proficient with Microsoft OfficeQualificationsRequired
Associate's Degree
10 years of relevant experience in related field
Preferred
Bachelor's Degree or equivalent
Familiar with ACA guidelines
Proficient with Excel
Health Plan experience
About Corewell HealthAs a team member at Corewell Health, you will play an essential role in delivering personalized health care to our patients, members and our communities. We are committed to cultivating and investing in YOU. Our top-notch teams are comprised of collaborators, leaders and innovators that continue to build on one shared mission statement - to improve health, instill humanity and inspire hope. Join a nationally recognized health system with an ambitious vision of continued advancement and excellence.How Corewell Health cares for you
Comprehensive benefits package to meet your financial, health, and work/life balance goals. Learn more here (https://careers.corewellhealth.org/us/en/benefits-new) .
On-demand pay program powered by Payactiv
Discounts directory with deals on the things that matter to you, like restaurants, phone plans, spas, and more!
Optional identity theft protection, home and auto insurance, pet insurance
Traditional and Roth retirement options with service contribution and match savings
Eligibility for benefits is determined by employment type and status
Primary LocationSITE - American Center - 27777 Franklin Rd - SouthfieldDepartment NamePH - Market Operations - IndividualEmployment TypeFull timeShiftDay (United States of America)Weekly Scheduled Hours40Hours of Work8 a.m. to 5 p.m.Days WorkedMonday to FridayWeekend FrequencyN/ACURRENT COREWELL HEALTH TEAM MEMBERS – Please apply through Find Jobs from your Workday team member account. This career site is for Non-Corewell Health team members only. Corewell Health is committed to providing a safe environment for our team members, patients, visitors, and community. We require a drug-free workplace and require team members to comply with the MMR, Varicella, Tdap, and Influenza vaccine requirement if in an on-site or hybrid workplace category. We are committed to supporting prospective team members who require reasonable accommodations to participate in the job application process, to perform the essential functions of a job, or to enjoy equal benefits and privileges of employment due to a disability, pregnancy, or sincerely held religious belief.Corewell Health grants equal employment opportunity to all qualified persons without regard to race, color, national origin, sex, disability, age, religion, genetic information, marital status, height, weight, gender, pregnancy, sexual orientation, gender identity or expression, veteran status, or any other legally protected category.An interconnected, collaborative culture where all are encouraged to bring their whole selves to work, is vital to the health of our organization. As a health system, we advocate for equity as we care for our patients, our communities, and each other. From workshops that develop cultural intelligence, to our inclusion resource groups for people to find community and empowerment at work, we are dedicated to ongoing resources that advance our values of diversity, equity, and inclusion in all that we do. We invite those that share in our commitment to join our team.You may request assistance in completing the application process by calling 616.486.7447.
