The Enrollment, Billing, and EDI Director is responsible for managing and coordinating key health insurance operational processes. Works closely with all members of the management team to provide support and guidance as it relates to Enrollment, Billing, and EDI work.
Displays a high degree of analytical ability to comprehend, interpret, and explain various Enrollment, Billing, and EDI processes to a diverse audience.
Position is responsible for systematic approaches that contribute to the enrollment of Priority Health members and the collection of premium revenue. Enhances and maintains a properly functioning Enrollment, Billing, and EDI processes through a cross-department organizational structure.
Key Functions Include:
• Provides leadership over the end to end process for on-boarding new and renewal employer groups and members. Oversees the following business units: EDI-Operations, Enrollment, Billing, and Fulfillment. Establishes and meets service level standards for the department. Defines standard work flow and improves the quality and unit cost of department activities.
• Responsible for developing staffing and production forecasts on a routine and timely basis. Accurate and timely communications to members and groups regarding benefit and membership materials, rate changes, premium invoices, etc.
• Responsible for ensuring electronic data interfaces support business requirements. Sets and achieves goals for EDI service standards. Provides strategic direction for the EDI operations business unit.
• Hires, coaches, and leads the team and staff. Establishes and maintains effective working relationships within the organization and provides consultation/support and troubleshooting on critical business problems. Accountable for and manages the budget for staff, materials and contracts that support the department activities. Provides direction that impacts group and member relations such as timeliness and quality of systems data entry and related customer experience, premium revenue stream, regulatory compliance and overall production costs.
• Sets strategic direction for Enrollment, Billing, and EDI, ensures strategic goals are met, and actively communicates with key stakeholders. Establishes and maintains effective working relationships within the organization and provides consultation/support and troubleshooting on critical business problems.
Basic Qualifications: Education - Bachelor's Degree in Business Administration, Finance or Computer Science Experience - 7 years of experience typically gained through skills/knowledge/abilities in management experience in a service industry. 3 years of experience typically gained through skills/knowledge/abilities in proven experience in training and mentoring others
Employer will assist with relocation costs.
Additional Salary Information: Annual bonus - 20% of base salary
Internal Number: 76601
About Spectrum Health
Spectrum Health is a not-for-profit, award winning, integrated health system based in West Michigan. Our organization includes a medical center, regional community hospitals, a dedicated children's hospital, a multispecialty medical group and a nationally recognized health plan, Priority Health. We invest in our people by supporting a dynamic, high-performing workplace. Our collaborative approach to patient care includes a commitment to provide an exceptional experience for patients and their families. Spectrum Health supports successful career growth in an innovative environment.