Project Leader - Customer & Enrollment Services
Under the direction of the Director of Customer and Enrollment Services, the Project Leader is responsible for ensuring accurate enrollment and eligibility data for Medicare, Medicaid and Commercial clients. Communicates and coordinates enrollment information with InfoCrossing for maximum member reimbursement and payment forecasting. Maintains enrollment matrixes for the Health Plan and provides feedback to management, as necessary to ensure eligibility and enrollment rules are administered correctly. The Project Leader provides support to the Customer and Enrollment Services teams/staff by providing accurate data, membership counts and reporting needed for member retention and enrollment objectives for Customer and Enrollment Services.Responsibilities:
Serves as project leader for start up and/or implementation of designated projects including but not limited to project definition, planning, project plan maintenance, business process and systems implementation, performance measurement systems, benchmarking and project facilitation including development of new protocols, processes and tools for evaluation and/or monitoring projects.
Develops and delivers progress reports, proposals, requirements, documentation and presentations.
Coordinates the department’s development of responses to request for proposals (RFP), including facilitation and development of standard responses.
Performs enrollment data analysis to ensure data integrity and accurate enrollment reporting for all plans and lines of business.
Develops analytical tools, compiles data and analyzes outcomes to measure the effectiveness of department programs.Serves as project leader for ad hoc Customer and Enrollment Services projects, including development of new protocols, processes and tools for evaluation and/or monitoring of Customer and Enrollment Services concerns.Coordinates with the Training Unit to document and maintain all training materials for member, enrollment, pharmacy prior authorization and medical prior authorization.
Serves as lead for Customer and Enrollment Services standardization activities, including but not limited to coordination with Schaller Plans for development of business standards of practice, policies, desktops and tool kits.
Serves as lead for new business integration.
Leads process to evaluate user requirements for system enhancements as required by Schaller Anderson business and/or contractual requirements. This includes performing a thorough analysis to determine whether programming, system configuration and/or operational procedure changes offer the “best choice” resolution; and works with management to determine appropriate distribution of workload to meet deadlines and maximize use of available resources.
Coordinates with operational staff to ensure system changes meet user approval and obtain sign-off prior to implementing changes into production.
Coordinates with the Manager of Enrollment services to implement ongoing changes in Medicare eligibility and enrollment technical functions.
Serves as department representative at various meetings, and works on various projects with organizations including state and federal agencies and with other community agencies and contracted providers.
Assists in annual budget preparation and determination of Customer and Enrollment Services financial needs.
Performs other related duties as assigned or necessary to ensure the success of the Customer and Enrollment Services department.ABOUT SCHALLER ANDERSON:Schaller Anderson administers Medicaid and employer self-funded health plans, and manages behavioral health plans. The company’s suite of services includes member services; provider services; claims processing; information services; financial reporting and analysis; medical management; and grievances and appeals services. Schaller Anderson has also been engaged in several consulting projects for states, health plans and providers. Schaller Anderson and its affiliates have 1,400+ employees nationwide and administer health plans with over 1.6 million members. Recently, the Initiative for a Competitive Inner City and Inc. magazine named Schaller Anderson to the Inner City 100, a list that recognizes the fastest-growing companies in America’s core urban areas. Schaller Anderson placed eighth among 5,000 entries in the Inner City 100 competition and was the only health care management company in the top 10.The VISION of Schaller Anderson, Inc. is to be recognized as the nation’s foremost managed care resource by providing the highest value management and consulting services throughout the health care continuum.
BENEFITS:Schaller Anderson team members are provided with countless opportunities to make a real difference and the following compensation/benefits:* Competitive compensation DOE
* Medical, Dental and Vision insurance
* Employee Assistance Program
* Flexible spending accounts
* On-site fitness center (Phoenix headquarters only)* Life insurance and accidental death and dismemberment insurance
* Short-term and long-term disability
* Paid holidays, paid time off/paid time off reserve* 401(k) and profit sharing
* Tuition reimbursement
Knowledge and Skills:
Thorough understanding of concepts and practices of project management
Basic understanding of research design and methodology; ability to interpret, analyze and integrate quantitative and qualitative data; familiarity with social marketing concepts
Complex choice of action – requires considerable logic, understanding to analyze problem and determine course of action.
Requires work of unusual difficulty in the design, implementation and evaluation of systems or programs
Ability to prepare analytical reports with recommendations
Reads, writes and orally communicates at a level to correctly solicit/explain information to members with lower literacy skills.
Excellent verbal and writing skills; ability to write well and succinctly at all reading levels
Ability to design and develop health education/outreach materials
Must be able to use personal computer and other office equipment
Must have advanced interpersonal skills, maturity, and good judgment
Education and Work Experience:
Bachelor Degree in a Health related field is strongly preferred, although an equivalent combination of formal education and experience may substitute for a degree
Project management certification preferred
Minimum of three years of experience in a health care environment, two years in a program design and analysis capacity
Proficiency in use of software programs, including word processing, PowerPoint, Project, spreadsheets and others