Blue Cross of Idaho (BCI) is seeking an experienced Director, Enrollment and Billing to oversee member enrollment and billing activities. This leadership role will develop strategies, implement process improvements, ensure regulatory compliance, and champion quality excellence. The Director will evaluate enrollment and billing performance, enhance the customer experience, and drive operational efficiency. The ideal candidate will find opportunities for improvement, develop and implement solution plans, coach team members, and achieve key performance metrics. Reporting to the VP, Business Operations, this role will work onsite in Meridian Idaho. #LI-Onsite
Key Responsibilities:
Strategic Leadership: Develop and implement strategies for enrollment and billing operations. Lead initiatives to improve process efficiency and quality standards.
Performance Evaluation: Establish and maintain systems to evaluate the performance of enrollment and billing processes. Monitor key metrics to ensure objectives are met.
Regulatory Compliance: Ensure all activities align with relevant federal, state, and local regulations, including Medicare and CMS requirements.
Customer Experience: Enhance the member experience by implementing customer-focused improvements and monitoring Net Promoter Scores (NPS).
Team Management: Lead, coach, and develop the enrollment and billing team. Promote a positive and inclusive work environment.
Financial Oversight: Prepare and manage the department's budget, ensuring expenditures align with approved budgets. Implement cost-saving measures where applicable.
Collaboration and Communication: Work closely with other departments and business partners to ensure effective communication and collaboration. Report significant issues and events to senior management.
Policy Development: Develop and maintain departmental policies and procedures that support company goals and regulatory requirements.
Training and Development: Direct the design and implementation of training programs and computer-based training, to enhance team skills and knowledge. Evaluate the effectiveness of training initiatives.
To be considered for this opportunity you have:
Experience: Ten (10) years' experience in health insurance industry or healthcare revenue services to include management experience
Education: Bachelor's Degree in Quantitative field, Business, or Healthcare Administration preferred; or equivalent work experience (Two years' relevant work experience is equivalent to one-year college)
We'd also love it if you had:
MBA
Regulatory Experience
Claims and/or Customer Service Experience
Experience in the healthcare industry
Knowledge, Skills and Abilities (KSAs) needed in this role:
Knowledge of:
Leadership development and coaching concepts
Facets Claims Processing System
Benefit Focus or other enrollment tools
Medicare and CMS regulatory requirements
Member Billing and Broker Commission
Budgeting and basic accounting principles
Business development and presentations
Lean six sigma concepts
Customer Service and Net Promoter Scoring
Quality assurance approaches and development of Key Performance Indicators and business analytics
Components and principles of management production control and data processing management information systems that affect claims processing
Accounting principles, business budgeting processes, forecasting and planning techniques
Health insurance contract benefits and provisions and healthcare billing policies
Ability to develop and maintain effective working relationships at all levels
Skills:
Strong collaboration and business insight
Strong people leadership experience
Excellent verbal and written communication
Excellent motivational and staff recognition
Here's what your day may look like:
Assure cost effective high service levels to members and providers through fair, accurate, consistent and timely enrollment/eligibility processing.
Assure that national and corporate standards are met for timeliness and accuracy in enrollment processing. Participate in the establishment and negotiation of performance guarantee standards for large group accounts. Ensure these standards are met for areas under Director's purview.
Represent Enrollment and Billing operational perspective in a productive manner and participate in the debate/analysis of the pros and cons of the issues when corporate business rules are developed.
Assure effective communication with department, division, and corporate levels of management by reporting significant issues and events on a timely basis. Promptly report significant issues and events to the Vice President.
Assure that department management information systems, group and individual enrollment and billing systems, and reporting capabilities are in place and accurately reflect the work environment and outcomes.
Assure effective development and implementation of corporate initiative and projects by participating as a member of the related project steering committees when assigned.
Establish department objectives that support company goals and produce regular status reports.
Prepare an operating budget that reflects the forecasted needs of the department and control expenditures to assure adherence to approved budgets.
Ensure effective workflows, improve system efficiencies, monitor quality performance measures and confirm appropriate completion of work assignments. Make recommendations for change as appropriate.
Initiate personnel actions such as hiring, disciplinary, termination and/or salary recommendations.
Participate in training, coaching and motivation of employees including career path development. Assess individual employee performance and conduct timely performance appraisals.
Promote teamwork, discussion, and cooperation among staff and other departments. Ensure timely communication and sharing of information with team members.
Work with staff to resolve work-related issues and concerns. Promote a respectful and diverse workplace.
Develop and maintain departmental policies and procedures.
Direct the design, planning, and implementation of training aligned with the objectives and strategies of the operational areas.
Collaborate functional management to assess on\going and future training and development needs, as well as, the effectiveness of current training programs.
Approve new training techniques and suggest enhancements to existing training programs.
Oversee and establish relationships with vendors to provide additional outside training programs.
Perform other duties and responsibilities as assigned.
Reasonable accommodations: To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed above are representative of the knowledge, skill and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
We are an Equal Opportunity Employer and do not discriminate against any employee or applicant for employment because of race, color, sex, age, national origin, religion, sexual orientation, gender identity, status as a veteran, and basis of disability or any other federal, state or local protected class.
