Director, Enrollment Operations – Duals Special Needs Enrollment Experience Required

This is a fully remote position, open to applicants in United States.

📋 Description

• Oversee comprehensive enrollment operations across various markets, which encompass prospective enrollment, automatic enrollment, disenrollment, and reinstatement.

• Direct the integration of enrollment operations for newly acquired or merging health plans, focusing on system alignment, data migration, and standardizing processes.

• Develop and manage an enterprise enrollment oversight framework that includes reconciliation methodologies, cross-system validation, and executive reporting.

• Formulate and implement an enrollment operations strategy that aligns with product growth, regulatory obligations, and market expansion.

• Collaborate with IT on enhancing systems, data governance, and integration strategies.

• Oversee vendor relationships and manage enrollment partners to ensure SLA compliance and address enrollment exceptions.

• Propel transformation initiatives such as automation, AI-driven reconciliation, and process optimization.

• Track KPIs and operational metrics to pinpoint risks, compliance issues, trends, and areas for improvement.

• Lead, nurture, and manage teams engaged in enrollment operations.

• Supervise enrollment, regulatory compliance, financial matters, and vendor reconciliation activities.

• Ensure adherence to CMS, Medicaid, and state regulations through readiness for audits, responding to audits, legislative tracking, and corrective action planning.

• Manage CMS 834/820 transactions, state data feeds, and reconciliation processes.

• Create and enforce enrollment policies, procedures, and internal controls.

• Execute other job-related responsibilities as assigned.

⛳️ Requirements

• A bachelor's degree in accounting, finance, healthcare management, or a related field is mandatory.

• Equivalent relevant work experience may be considered in place of the required educational qualifications.

• A minimum of seven (7) years of leadership and management experience is required.

• At least five (5) years of experience in business operations or a comparable role, preferably within a healthcare setting, is necessary.

• Experience in Medicaid managed care, Medicare Advantage, Dual Special Needs Plan (D-SNP), or related healthcare fields is required.

• Proven experience in leading system integrations, mergers, or operational transformations.

• Comprehensive understanding of enrollment operations, CMS regulations, Medicaid procedures, and healthcare operational workflows.

• Demonstrated capability in designing and operationalizing enterprise oversight frameworks, including dashboards and reconciliation models.

• Familiarity with healthcare systems such as TriZetto EAM, Facets, MARx, HPMS, and MMIS platforms is preferred.

• Strong understanding of compliance, audit, and regulatory frameworks, including both internal and external controls.

• Ability to devise a long-term enrollment strategy while executing short-term initiatives.

• Exceptional analytical and problem-solving skills, with the capability to manage competing priorities and deadlines.

• Proven leadership skills, including team development, engagement, and performance management.

• Effective interaction with all management levels is necessary.

• Advanced computer skills, particularly in Microsoft Office; ability to quickly learn new technologies is essential.

• Excellent interpersonal, written, and verbal communication skills, along with change management abilities.

• A general understanding of IT environments is preferred.

• Willingness to travel as required by business needs.

🏝️ Benefits

• Potential bonus tied to both company and individual performance.

• Comprehensive total rewards package.

• Support for employee total well-being.