Claims and Enrollment Manager

Company: New Mexico Health Connections

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General Information
US-NM-Albuquerque
N/A
Not Specified
Full-Time
At least 5 year(s)
Not Specified
False
False
Job Description Claims and Enrollment Manager

We are New Mexico’s new non-profit consumer oriented and operated health plan.

  • We are a health plan focused on the well-being of patients by ensuring coordinated care at every level
  • We are focused on serving individuals and small businesses across New Mexico
  • We are chartered by the Affordable Care Act to provide a non-profit affordable health plan alternative in the New Mexico marketplace
  • We recognize our members do best through strong relationships with their health care providers and that a strong network of primary-care providers is critical to ensuring the good health of our members
  • Our priority:  keeping people healthy, lowering premiums costs and delivering appropriate levels of care at the right time to keep you home and out of the hospital

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    Job Description

  • Reports to Chief Operating Officer and works closely with the Product Development and Communications Manager and Director of Provider Services
  • Responsible for managing the oversight of administrative operations of the Claims and Enrollment function performed by the third party administrator (TPA)
  • Responsible for managing the oversight of electronic eligibility feeds from various constituencies, including the state exchange and contracted vendors
  • Develops, implements and monitors claims and enrollment measurement standards and establishes goals and quality standards
  • Promotes coordination between NMHCs Provider Network Services and the TPA’s claim and enrollment areas
  • Supports programmatic development of policies and procedures and workflows are optimally designed to ensure adherence with state and federal requirements
  • Provides support to staff, investigates and resolves complex issues
  • Participates and provides strategic input on enrollment strategies to support optimal membership growth for NMHC
  • Provides oversight and audit functions for benefit configuration and enrollment data
  • Participates in appropriate meetings on health CO-OPs at the federal, state and local levels, and with the CO-OPs national trade organization to share information and identify best practices for New Mexico Health Connections
  • Participates in and manages other duties as assigned

    • Job Requirements Claims and Enrollment Manager

    • Bachelor degree preferred
    • 5 + years of claims and enrollment experience at the supervisor level
    • Detailed knowledge of Managed Care and Commercial claims and enrollment processes
    • Ability to drive claims and enrollment functions development and meet deadlines
    • Ability to identify and implement program changes as necessary
    • Ability to communicate and manage contracted business partners
    • Experience in the New Mexico health insurance market preferred
    • Expertise utilizing Microsoft Office
     

    Please submit cover letter resume to [Click Here to Email Your Resumé]

     

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