Job Summary: 

• Ensure compliance with all corporate and departmental standards
• Meet with employees regularly to discuss performance and quality
• Report on Key Performance Metrics (KPIs) to the Executive Director of Claims
• Ensure adequate resources and technology are in place
• Develop and implement departmental standards and expectations
• Analyze and process a variety of claim files to ensure the execution of standardized claim protocol and claim handling
• Oversee the Enrollment process for contracted lines of business according to the business rules taught in the training program.
• Ensure that the department practices meet or exceed the client’s processing standards, procedures, and service level agreements
• Must be knowledgeable in healthcare and the enrollment process for health plan recipients.
• Identify process improvement opportunities within the Enrollment process and recommend system enhancements
• Interact with the Client daily to ensure the communication is a positive one and we are managing the SLAs together.

Skills on Resume:

• Compliance Management (Hard Skills)
• Performance Evaluation (Soft Skills)
• Reporting (Hard Skills)
• Resource Management (Hard Skills)
• Process Implementation (Hard Skills)
• Claims Analysis (Hard Skills)
• Client Management (Soft Skills)
• Process Improvement (Hard Skills) 

Job Summary: 

• Oversees and directs the activities of the contractors who interface with members.
• Anticipates and identifies problems related to marketing and enrollment activities.
• Issues including situations where policy or procedures are incompatible with System goals, ineffective or inefficient in building and maintaining member enrollment.
• Closely monitors contractor duties to ensure contract compliance and contractor commitment to assuring all activities are performed in a manner
• Enhance the member experience and assure member satisfaction consistent with CCH health plan policies and operational procedures and standards.
• Monitors activity measures and performance indicator reports from contractors. Identify accomplishments and areas of concern.
• Meet regularly with contractor leadership to discuss successes, problem areas, and contract compliance with an eye to continuous improvement.
• Identifies and reports to CCH leadership patient and member satisfaction concerns.
• Monitors and oversees CCH media and outreach activities.
• Ensures the timely intervention of member issues to enhance customer satisfaction and retention.
• Recommends and implements changes in guidelines, procedures, and policies to comply with changes in federal and state regulatory requirements or to improve efficiencies and performance.

Skills on Resume:

• Contractor Management (Soft Skills)
• Problem Identification (Soft Skills)
• Contract Compliance (Hard Skills)
• Member Experience Enhancement (Soft Skills)
• Performance Monitoring (Hard Skills)
• Leadership Communication (Soft Skills)
• Satisfaction Reporting (Hard Skills)
• Policy and Procedure Improvement (Hard Skills) 

Job Summary: 

• Lead (virtual) presentations and events to represent the MicroCollege program.
• Respond warmly and accurately to phone, SMS, chat, and email inquiries from applicants who are interested in learning about or receiving information about MicroCollege.
• Ensure coverage of phone lines during business hours, so students receive a live, personal answer and do not go to voicemail or give up and hang up.
• Assist students and families with the enrollment process.
• Make outbound phone, SMS, and email campaigns to potential students who have expressed interest in enrolling in MicroCollege.
• Coordinate and communicate continuously with other departments to share information, best practices, systems issues, process solutions, and training needs
• Oversee the EDI Enrollment process for electronic connectivity, Electronic Remittance Advice (ERA), and Electronic Funds Transfer (EFT) including coordination with clearinghouse
• Ensure compliance with company and departmental policies and procedures
• Establish and review internal controls to ensure goals, objectives, standards, and benchmarks for the department are met or exceeded
• Determine staff hours, number of personnel, and resources required for efficiency
• Promote continuous improvement and best practices in processes and performance for improving enrollment, timeliness, and ensuring data accuracy
• Lead in the creation and maintenance of a positive working environment

Skills on Resume:

• Presentation Skills (Soft Skills)
• Customer Service (Soft Skills)
• Enrollment Assistance (Soft Skills)
• Outbound Campaigns (Hard Skills)
• Cross-Department Communication (Soft Skills)
• EDI Enrollment Management (Hard Skills)
• Compliance Management (Hard Skills)
• Process Improvement (Hard Skills) 

Job Summary: 

• Ensure that all GEDC providers are credentialed and enrolled according to NCQA standards.
• Compile, evaluate, and present the provider-specific data collected for review by one or more decision-making bodies.
• Work with GEDC staff and GEDC’s legal dept to ensure timely completion of primary source verification and submission of doctor credentialing and re-credentialing files to the Credentialing Committee
• Manage all administrative aspects of the Credentialing Committee
• Verifies and documents expire using acceptable verification sources to ensure compliance with accreditation and regulatory standards.
• Communicates findings and/or resulting actions to key stakeholders and the provider.
• Collaborate with IT and with payers to identify delegated reporting requirements and develop required reports for payers
• Ensure timely and accurate submission of reports required for payers with whom GEDC is contracted.
• Participate in/Run calls with payers and with regions
• Recognizes, investigates, and validates discrepancies and adverse information obtained from the application, primary source verifications, or other sources.
• Ensure timely and accurate handling of credentialing and re-credentialing correspondence sent to GEDC

Skills on Resume:

• Credentialing (Hard Skills)
• Data Evaluation (Hard Skills)
• Primary Source Verification (Hard Skills)
• Committee Management (Soft Skills)
• Compliance Verification (Hard Skills)
• Stakeholder Communication (Soft Skills)
• Reporting (Hard Skills)
• Issue Resolution (Soft Skills) 

Job Summary: 

• Maintain up-to-date and comprehensive documentation as it relates to credentialing, delegated credentialing, and re-credentialing
• Ensure resolution and responses to inquiries from the regions following credentialing policies
• Conduct root cause analyses and implement process improvements
• Recruits and supervises qualified staff to accomplish departmental operations and functions.
• Oversee data clean-up and other tasks to maintain the integrity of data in GEDC’s systems
• Assist in the enhancement of GEDC’s systems to better support the credentialing, provider enrollment, and re-credentialing functions.
• Ensure timely submission of directory validation, roster requests, and other routine and ad hoc requests from payers
• Assist in the implementation of credentialing software.
• Oversees credentialing database ensuring accurate and current information is available to all stakeholders.
• Collaborate with others in the credentialing, revenue cycle, payer relations, and other GEDC departments to improve workflow/process and resolve issues

Skills on Resume:

• Documentation Management (Hard Skills)
• Issue Resolution (Soft Skills)
• Root Cause Analysis (Hard Skills)
• Staff Recruitment (Soft Skills)
• Data Integrity (Hard Skills)
• System Enhancement (Hard Skills)
• Submission Management (Hard Skills)
• Cross-Department Collaboration (Soft Skills) 

Job Summary: 

• Coordinates with DSO, Principal, and SIS support team at Acadia to create student schedules and update them periodically
• Manages logistics and timeline for report cards/progress reports/transcripts.
• Coordinates grading processes, verification and correction of grades, finalizing incompletes, printing, and distribution of report cards and progress reports, and on-time delivery of grades, report cards, progress reports, and transcripts.
• Maintains all digital course records and teacher/administrative access to the online gradebook.
• Build and ensure accurate final transcripts for college applications.
• Works closely with the college counseling team to execute verification of enrollment and ensure the accuracy of transcripts for students to transmit to colleges and universities.
• Maintains student transcripts and runs them for easy retrieval at each quarter and semester.
• Ensures that transfer grades and GPAs are calculated correctly and reflected appropriately in the student information system.
• Processes credit checks each semester/trimester to ensure all students are on course to graduation.
• Coordinates with the College Counseling Team so they have quick access to data and reports for college applications, etc.

Skills on Resume:

• Schedule Coordination (Soft Skills)
• Report Management (Hard Skills)
• Grading Process Management (Hard Skills)
• Digital Record Keeping (Hard Skills)
• Transcript Management (Hard Skills)
• Enrollment Verification (Hard Skills)
• Data Accuracy (Hard Skills)
• Cross-Department Collaboration (Soft Skills) 

Job Summary: 

• Manage enrollment team and oversee all enrollment-related functions.
• Facilitate and/or assist with the automated enrollment process for the assigned markets, including automated monthly loads, member reconciliation, member notifications, newborn enrollments, and preemie dis-enrollments for DC.
• Review and reconcile daily, and weekly fallout/exceptions reports.
• Perform and/or assist with the mass PCP changes, Provider Terminations, and maximum Provider Panel Closings.
• Submit accurate and timely regulatory reporting, and participate in regulatory audits.
• Utilize strong analytics skills and provide high-level reporting to leadership.
• Validate and update District TPL/COB in MHC and prepare reports.
• Perform regular vendor enrollment reconciliation and troubleshoot vendor enrollment issues.
• Ensure all team documentation that goes to DHCF is accurate, complete, and timely, inclusive of all paperwork associated with newborns and disenrollments.
• Create and maintain policies, procedures, and SOPs to ensure compliance with District contracts.
• Oversee the enrollment claims queue ensuring timely working of all claims.

Skills on Resume:

• Team Leadership (Soft Skills)
• Enrollment Automation (Hard Skills)
• Data Reconciliation (Hard Skills)
• Compliance (Hard Skills)
• Reporting (Hard Skills)
• Vendor Management (Soft Skills)
• Policy Creation (Hard Skills)
• Claims Processing (Hard Skills) 

Job Summary: 

• Support the Director of Enrollment by proposing policy and procedural changes to improve student retention and degree attainment.
• Manage the day-to-day processes and point of contact for Admissions, Registrar, RPI, etc. regularly.
• Point of contact in the absence of Director Enrollment availability.
• Manage daily functions for a team of Enrollment Advisors through coaching opportunities, mentor identified leaders on the team, and guide new hires.
• Provide ongoing coaching and motivation of enrollment representatives to achieve objectives by providing tools and creating motivation to encourage individual and team development as well as revenue and profit growth.
• Meet and exceed enrollment goals as set by company objectives.
• Collaborate with peers to identify and develop best practices to contribute to the growth of the business.
• Responsible for submitting annual reviews for approval with subsequent delivery of reviews to Enrollment Advisors.
• Participate in interviewing and selection of new enrollment staff.
• Support the development of new strategies for success for the enrollment department.
• Participate in project assignments representing the Enrollment Business Unit for the organization.

Skills on Resume:

• Policy Development (Hard Skills)
• Team Management (Soft Skills)
• Coaching (Soft Skills)
• Goal Achievement (Soft Skills)
• Collaboration (Soft Skills)
• Performance Reviews (Hard Skills)
• Recruitment (Soft Skills)
• Strategic Planning (Hard Skills) 

Job Summary: 

• Develop, execute, and optimize advertising and marketing activity to national/international audiences via marketing automation, CRM, social media, paid advertising, and other systems and channels.
• Develop and manage key marketing content and collateral to increase website traffic (SEO) to program-specific pages on the IHP website, support social media marketing strategy, generate leads, and raise visibility and awareness.
• Manage email/mail list purchases/rentals, e.g., GRE, and NAAHP to execute marketing plans.
• Work with external partners (digital marketing vendor, freelance designer, and others to execute marketing plans
• Work with internal partners (e.g., Office of Strategic Communications, IT) on content and video production
• Conduct market research and competitive analysis regularly as part of the marketing planning process to compare programs along a spectrum of attributes (tuition, application requirements, key messages, etc).
• Oversee and coordinate marketing support for in-person and virtual events, including informational webinars, conferences, and other recruitment events with the potential for lead generation, in close collaboration with Admission staff.
• Using data to inform decisions, create and implement strategies to engage target audiences, including donors, prospective students, alumni, parents, community partners, and peer institutions.
• Ensure the regular production of valuable and engaging content for the website, social media accounts, and blogs by managing relationships with team members.

Skills on Resume:

• Marketing Strategy (Hard Skills)
• Content Development (Hard Skills)
• Email Marketing (Hard Skills)
• Vendor Management (Soft Skills)
• Market Research (Hard Skills)
• Event Coordination (Soft Skills)
• Data-Driven Decision Making (Hard Skills)
• Content Management (Hard Skills)