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CalOptima · 18 hours ago

Director Premium Billing and Member Enrollment (Director II)

Orange, CA

Full-time

Onsite

Director/Executive

$181K/yr - $290K/yr

7+ years exp

CalOptima is a mission-driven community-based organization that serves member health with excellence and dignity. They are seeking a Director Premium Billing and Member Enrollment to lead the Enrollment and Billing function related to Health Insurance Exchange operations, ensuring seamless enrollment and accurate billing while driving regulatory compliance.

GovernmentHealth CareNon Profit

Comp. & Benefits

Responsibilities

Cultivates and promotes a mission-driven culture of high-quality performance, with a member focus on customer service, consistency, dignity and accountability

Directs and assists the team in carrying out department responsibilities and collaborates with the leadership team and staff to support short- and long-term goals/priorities for the department

Directs, hires and trains department managers and staff

Reviews and develops the performance of department staff and sets monthly or quarterly goals

Serves as the key point of contact and advisor for executive leadership when making strategic decisions impacting the operations of the Enrollment and Billing function at CalOptima Health

Develops and executes the 12-18-month roadmap to operationalize Enrollment and Billing capabilities for Covered California line of business - integrating with existing Medi-Cal workflows (where applicable), defining new operational processes, and configuring existing and/or new systems to support Covered California line of business

Builds out and leads Enrollment and Billing function at CalOptima Health (i.e., recruiting, coaching, and retaining team, setting up governance structure, collaborating cross-functionally with other CalOptima Health functions to identify teams' dependencies, etc.)

Oversees the timely and accurate completion of Covered California enrollment capabilities inclusive of ingestion and processing of 834 enrollment files, plan changes, cancellations, and grace-period management per Covered California rules

Implements and oversees end-to-end premium billing capability -including invoice generation, member payments, financial reconciliation (including subsidies) and refunds-ensuring regulatory compliance

Reconciles membership and premium data with Covered California and internally at CalOptima Health to support regulatory requirements and data accuracy internally on a cyclical basis

Manages the end-to-end enrollment and billing processing and reconciliation for the off-exchange population

Oversees integration and management of the enrollment and billing capabilities that third party vendors and delegated health network are responsible and accountable for

Leads vendor and technology selection for vended capabilities and oversees implementation and integration with the organization's processes and technologies

Leads the development of processes and configuration of core admin system to support implementation and ongoing optimization of the premium billing capability at CalOptima - inclusive of partnering with CalOptima Health's Information Technology teams (and potentially vendor teams), overseeing system and data integrations, etc

Develops and manages the annual departmental budget

Completes other projects and duties as assigned

Qualification

Health insurance exchange experienceEnrollmentBilling managementLeadership experienceProgram oversightBudget managementAnalytical skillsCustomer service focusProject management skillsCommunication skillsTeam collaboration

Required

Bachelor's degree in business, health administration, finance, or related field PLUS 7 years in health-plan operations with at least 5 years in health insurance exchange/marketplace and/or commercial Individual and Family Plan (IFP) enrollment and billing required; an equivalent combination of education and experience sufficient to successfully perform the essential duties of the position such as those listed above may also be qualifying

3 years of progressive management/leadership experience required