Manager of Enrollment and Provider Data Management (Health Plans)

Summary

• Samaritan Health Plans (SHP) provides health insurance options to Samaritan employees, community employers, and Medicare and Medicaid members. SHP operates a portfolio of health plan products under several different legal structures: InterCommunityHealth Plans, Inc. (IHN) is designated as a regional Coordinated Care Organization (CCO) for Medicaid beneficiaries; Samaritan Health Plans, Inc. offers Medicare Advantage, Commercial Large Group, and Commercial Large Group PPO and EPO plans; SHP is also the third-party administrator for Samaritan Health Services’ self-funded employee health benefit plan.

As part of an Integrated Delivery System, Samaritan Health Plans is strategically and operationally aligned with Samaritan Health Services’ mission of Building Healthier Communities Together.

This is a remote position in which we are able to employ in the following states: Alabama, Alaska, Arizona, Arkansas, Connecticut, Florida, Georgia, Idaho, Indiana, Iowa, Kansas, Kentucky, Louisiana, Maryland, Michigan, Mississippi, Missouri, Montana, Nebraska, Nevada, New Hampshire, New Mexico, North Carolina, Oklahoma, Oregon, Rhode Island, South Carolina, South Dakota, Tennessee, Texas, Utah, Virginia, West Virginia, or Wisconsin

Occasionally

• JOB SUMMARY/PURPOSE
• Provides leadership, strategic direction, and operational oversight for Enrollment and Provider Data Management functions across all health plan lines of business, including Commercial, Medicare, Medicaid, and other health plan products. Responsible for ensuring accurate and timely member enrollment, eligibility maintenance, provider data management, provider directory accuracy, and regulatory compliance. Leads operational teams, develops business processes, monitors performance metrics, and collaborates with internal and external stakeholders to support organizational goals, regulatory requirements, operational excellence, and exceptional customer and provider experiences.
• EXPERIENCE/EDUCATION/QUALIFICATIONS
• Bachelor’s degree in healthcare administration, Business Administration, Information Systems, Public Health, or a related field; or equivalent combination of education and experience required.
• Five (5) years transitional operations experience in health plan operations required.
• Three (3) years of leadership experience required.
• Experience in the following preferred:
• Medicare Advantage, Medicaid, and Commercial health plan operations.
• Managing regulatory compliance, audits, and operational reporting.
• Enrollment platforms, provider data systems, claims systems, and healthcare technology applications.
• Project management, process improvement, or Lean practices.

KNOWLEDGE/SKILLS/ABILITIES
• Leadership - Inspires, motivates, and guides others toward accomplishing goals. Achieves desired results through effective people management.
• Conflict resolution - Influences others to build consensus and gain cooperation. Proactively resolves conflicts in a positive and constructive manner.
• Critical thinking - Identifies complex problems. Involves key parties, gathers pertinent data and considers various options in decision making process. Develops, evaluates and implements effective solutions.
• Communication and team building - Leads effectively with excellent verbal and written communication. Delegates and initiates/manages cross-functional teams and multi-disciplinary projects.
• Advanced knowledge of health plan enrollment, eligibility, provider data management, and healthcare operations. Knowledge of Medicare, Medicaid, Commercial, CMS, and State regulatory requirements.
• Ability to develop and monitor operational metrics and performance standards.
• Advanced proficiency with Microsoft Office applications and healthcare operational systems.
• PHYSICAL DEMANDS
• Rarely (1 - 10% of the time)
  

(11 - 33% of the time)

Frequently
(34 - 66% of the time)

Continually
(67 - 100% of the time)

LIFT (Floor to Waist: 0"-36") 0-20 Lbs

LIFT (Knee to chest: 24"-54") 0 - 20 Lbs

LIFT (Waist to Eye: up to 54") 0 - 20 Lbs

CARRY 1-handed, 0 - 20 pounds

CARRY 2-handed, 0 - 20 pounds

KNEEL (on knees)

BEND FORWARD at waist

CLIMB - STAIRS

STAND

WALK - LEVEL SURFACE

ROTATE TRUNK Standing

REACH - Upward

PUSH (0-20 pounds force)

PULL (0-20 pounds force)

SIT

ROTATE TRUNK Sitting

REACH - Forward

MANUAL DEXTERITY Hands/wrists

FINGER DEXTERITY

PINCH Fingers

GRASP Hand/Fist

None specified