This position is responsible for the daily operations of the Member Services Call Center and Eligibility Unit, including personnel, Member Services Operations Manager, Call Center Manager, and overall operational responsibilities.
Duties and Responsibilities
Provide day-to-day oversight and leadership support of the Call Center and Eligibility Unit Managers and staff
Responsible for the overall management of staff and their managers
Participate in committees and meetings as needed.
Ability to represent the Member Services Department in the absence of the Member Services Director.
Plans, develops, and makes necessary recommendations to assist in the organizational structure
Assist the Member Services Director with special assignments
Work with the Trainer, G&A & QI Manager, Operations, Call Center Managers/Supervisors, and Director to develop data and analytical reports, and track interventions and results.
Report progress
Overseas enrollment and disenrollment processes for all CenCal Health programs and works with the Operations Manager in the development of new member enrollment and monthly disenrollment outreach and data reporting
Works with external agencies for enrollment, disenrollment, and aid code issues
Assist with the development of system changes or upgrades as needed
Ensures that Enrollment Unit policies are updated and comply with regulatory requirements
Coordinate annual mailing to ensure regulatory requirements are met relating to mailing schedules
Ensure that all member enrollment material is updated and the correct version is used
Oversight for the auditing of the enrollment process
Develops written policies and procedures
Works closely with the Member Services Director to develop and maintain departmental policies
Work with the Director and Trainer to ensure the Member Services Call Center and Eligibility Unit training program meets the needs of the Call Center and Eligibility Unit
Provide project management for the Call Center and Eligibility Unit
Assist with compliance with DHCS, DMHC, CMS, and NCQA requirements and standards
Facilitate and/or attend appropriate committees, meetings, and trainings
Monitor Call Center and Eligibility metrics for appropriate reporting needs
Oversees and coordinates member mailings
Monitors member literature inventories
Participates in the development and revision of member materials
Reviews and analyzes documentation of calls and other Call Center activities
Provides for appropriate backup to the Call Center as needed
Facilitates the Consumer Advisory Board in the absence of the Director
Participate in any annual member focus groups as needed
Works with the Member Services Director on the development of member materials
Responsible for maintaining the Member Services section of the CenCal Health website
Other duties as assigned
Knowledge/Skills/Abilities
Required:
Strong Management experience in a managed healthcare environment
Minimum of five (5) years experience in the managed healthcare environment
Strong oral and written communication skills
Excellent management & supervisory skills with extensive knowledge of how to grow and maintain a positive work environment
Knowledge of, and ability to utilize, conflict resolution and problem-solving techniques
Thorough understanding and ability to provide data collection and analysis
Familiarity with the County Welfare Offices known as the Department of Social Services (DSS), Social Security Administration (SSA); county public health departments; FQHCs; local CBOs, and experience with quality standards such as NCQA, JACHO
Extensive knowledge of regulatory standards such as Knox-Keene, Titles 22, and 28
Education and Experience
Bachelor's Degree, Masters preferred, in Health Administration, Social Sciences, Business or related field
Five (5) years experience in a managed care environment or similar field
Experience and understanding of a call center environment
Familiarity with Medi-Cal and other entitlement programs
Understanding of managed care HIS and experience in working with programmers and analysts.
Experience with Commercial Medicare Advantage Plan or DSNP Lines of Business
Experience and knowledge of enrollment, premium billing, and disenrollment process for these LOBS.
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