Supervisor, Medicare Enrollment

Prominence Health is a value-based care organization bridging the gap between affiliated health systems and independent providers, building trust and collaboration between the two. Prominence Health creates value for populations and providers to strengthen integrated partnership, advance market opportunities, and improve outcomes for our patients and members. Founded in 1993, Prominence Health started as a health maintenance organization (HMO) and was acquired by a subsidiary of Universal Health Services, Inc. (UHS) in 2014. Prominence Health serves members, physicians, and health systems across Medicare, Medicare Advantage, Accountable Care Organizations, and commercial payer partnerships. Prominence Health is committed to transforming healthcare delivery by improving health outcomes while controlling costs and enhancing the patient experience.

Learn more at: https://prominence-health.com/

Job Summary:

The Supervisor of Medicare Enrollment is responsible for supervising the day-to-day operations of the Prominence Medicare Enrollment team. This position will support staff to ensure the enrollment process is in compliance according to CMS rules and regulations, accurate and timely. The Supervisor will develop and/or implement policies and procedures and analyze processes for improvement. In addition, this role is responsible for reconciliations pertaining to enrollment and remediation of enrollment escalations such as CTM Complaints, Appeals and Grievances. The supervisor partners with various internal/external entities in multiple geographic locations.

Job Duties/Responsibilities:

• Is familiar with all enrollment requirements for NCQA/HEDIS and assures compliance with each standard. Prepares all NCQA and HEDIS reports required for audits and accreditation. Meets all reporting deadlines 
• Provides weekly, monthly and annual enrollment performance reports for Health Care Operations Committee (HCOC), Medical Advisory Committee (MAC) and PHP Board meetings. Conducts presentation of these reports to various committees on a quarterly basis

• Has direct oversight of enrollment, premium billing and reconciliation processes and all related staff

Benefit Highlights:

• Loan Forgiveness Program 
• Challenging and rewarding work environment
• Competitive Compensation & Generous Paid Time Off
• Excellent Medical, Dental, Vision and Prescription Drug Plans
• 401(K) with company match and discounted stock plan
• SoFi Student Loan Refinancing Program
• Career development opportunities within UHS and its 300 Subsidiaries! · More information is available on our Benefits Guest Website: benefits.uhsguest.com

About Universal Health Services:

One of the nation’s largest and most respected providers of hospital and healthcare services, Universal Health Services, Inc. (UHS) has built an impressive record of achievement and performance. During the year, UHS was again recognized as one of the World’s Most Admired Companies by Fortune; and listed in Forbes ranking of America’s Largest Public Companies. Operating acute care hospitals, behavioral health facilities, outpatient facilities and ambulatory care access points, an insurance offering, a physician network and various related services located all over the U.S. States, Washington, D.C., Puerto Rico and the United Kingdom. www.uhs.com  

Qualifications and Requirements:

• Bachelor's degree or equivalent experience.
• 2 years of supervisory experience in Medicare enrollment and reconciliation required.
• At least 3 years’ experience working with health plans insurance products or employer healthcare benefits programs.
• At least 2 years of healthcare management experience including hiring, firing, employee coaching and training.
• Experience working with CMS contracted vendors and systems, such as Retroactive Processing Contractor (RPC), Wipro, MARx, etc. is preferred.
• Knowledge of CMS, LEP and LIS
• Knowledge of State and Federal regulations as they pertain to the health insurance industry and CMS enrollment and disenrollment regulations.
• Previous experience reviewing and analyzing statistical data to identify trends as well as potential problems/opportunities for improved service quality.
• Excellent verbal and written communication skills as well as public speaking and training abilities and experience
• Knowledge of various computer systems including all Microsoft Office systems, Outlook, and budgetary, time and attendance type software systems.
• Strong processes improvement skills necessary to get things done
• Knows how to organize people and activities
• Understands how to separate and combine tasks into efficient work flow
• Knows what to measure and how to measure it
• Can see opportunities for synergy and integration where others can't
• Can simplify complex processes
• Gets more out of few resources

EEO Statement

All UHS subsidiaries are committed to providing an environment of mutual respect where equal employment opportunities are available to all applicants and teammates. UHS subsidiaries are equal opportunity employers and as such, openly support and fully commit to recruitment, selection, placement, promotion and compensation of individuals without regard to race, color, religion, age, sex (including pregnancy, gender identity, and sexual orientation), genetic information, national origin, disability status, protected veteran status or any other characteristic protected by federal, state or local laws.

We believe that diversity and inclusion among our teammates is critical to our success.

Avoid and Report Recruitment Scams

At UHS and all our subsidiaries, our Human Resources departments and recruiters are here to help prospective candidates by matching skill set and experience with the best possible career path at UHS

and our subsidiaries. During the recruitment process, no recruiter or employee will request financial or personal information (e.g., Social Security Number, credit card or bank information, etc.) from you via email. Our recruiters will not email you from a public webmail client like Hotmail, Gmail, Yahoo Mail, etc.

If you suspect a fraudulent job posting or job-related email mentioning UHS or its subsidiaries, we encourage you to report such concerns to appropriate law enforcement. We encourage you to refer to legitimate UHS and UHS subsidiary career websites to verify job opportunities and not rely on unsolicited calls from recruiters.

If you would like to learn more about the opportunity, please contact Bridget Gomez at: bridget.gomez@uhsinc.com