Healthfirst Manager of Enrollment & Billing, CHP in New York, New York


The Manager, Enrollment & Billing is responsible for overseeing a defined line of business at Healthfirst. The incumbent will be responsible for participating in the development and implementation of operating policies & procedures which may include: enrollment; billing; reconciliation, audits, special projects, and back up support of other lines of business as needed or required. The role focuses on monitoring operational efficiency, accuracy, documentation and reporting quality outcomes and providing solutions that address the outcomes. In addition the Manager, Enrollment & Billing ensures deadlines are met and the life cycle of project implementation is executed timely and accurately. He/she will work cross-functionally with IT and Finance to ensure that processes are executed timely and accurately. This role is ultimately responsible to ensure the integrity of enrollment and payment data by implementing processes that compare state sources of enrollment information (834, roster, etc.) to our core enrollment and eligibility system to ensure that all enrollment and disenrollment activity is captured accurately and that Healthfirst is appropriately paid by the state and subscribers.

The role is responsible for monitoring employee performance and implementing improvement solutions as well as hiring new staff and overseeing all appropriate training. A Manager at Healthfirst functions as an advisor to a department, function, or organizational unit regarding duties, responsibilities, projects and/or activities. He/she is actively involved in daily operations only when required to meet schedules or resolve problems. His/her primary role is to implement and execute policies and to ensure that departmental priorities, schedules and deliverables are attained. This level typically has responsibility for achieving budget targets, planning, scheduling and procedural changes.

Duties and Responsibilities include:

  • Implements and communicates departmental standards

  • Manages employee performance and the quality of the team's work

  • Monitors productivity reports and department report card

  • Manages and develops Team Leads to be effective leaders

  • Works with Team Leads to establish and implement departmental goals, review goals on monthly basis and implement a Plan of Action where goals are not met

  • Ensures Team Leads are managing their team's performance through coaching, feedback, documentation and escalation to Human Resources where appropriate.

  • Engages with other operational units to ensure excellence in customer service and operational excellence

  • Partners with direct reports to resolve problems through root cause analysis and the identification and implementation of short term and long term solutions to the problems.

  • Reconciles Account Receivable variances for Medicare

  • Reviews document retention procedures

  • Communicates General Ledger vs. supportable variances to Finance Corp.

  • Additional duties as assigned

Compliance & Regulatory Responsibilities may include:

  • Managing reconciliation and reporting deliverable

  • Addressing internal and external audits

  • Responsible for state reconciliation and any related reporting deliverables

  • Participate in and lead state operations and technical calls

  • Support audits by providing data/universes for audit requests

  • Interact with regulatory authorities as needed to support enrollment and billing processes

Minimum Qualifications:

  • Leadership experience in a high volume production billing, enrollment, claims, call center environment or related environment.

  • Background in providing customer service or improving the member’s experience while addressing customer issues and complaints in a timely manner.

  • Direct supervisory or management experience in an operational department within the healthcare industry (which can include commercial insurance plan, hospital, nursing home, third party administrators, or other related area).

  • Experience managing inventories, overseeing performance management (production based metrics) and staff development of assigned personnel.

  • Understanding of member billing or enrollment processes in order to optimize and streamline current processes effectively (as needed).

  • Experience addressing, documenting, managing employee relation issues (i.e. attendance, tardiness, or behavioral concerns) and fostering positive employee relations.

  • Experience providing project direction, supporting training and development, administering company policies.

  • Strong communication and presentation skills through all levels.

  • Bachelor's degree from an accredited institution or equivalent work experience

Preferred Qualifications:

  • Any experience with employee performance management systems.

  • Experience with User Acceptance Testing, Data Analysis/Reporting and defining Business Requirements.

  • Demonstrate the ability to effectively work cross-division for successful outcomes.

  • Familiar with the HIPAA 834 Specifications and/or other electronic transmission of data.

  • Demonstrate a sense of urgency in problem resolution and management.

  • Can oversee the implementation of projects and effectively communicate outcomes with all level staff.

  • Keeps up to date with healthcare practices, laws regulations and trends through participation in professional development activities.

Compliance & Regulatory Responsibilities: See Above

License/Certification: N/A

WE ARE AN EQUAL OPPORTUNITY EMPLOYER. Applicants and employees are considered for positions and are evaluated without regard to mental or physical disability, race, color, religion, gender, national origin, age, genetic information, military or veteran status, sexual orientation, marital status or any other protected Federal, State/Province or Local status unrelated to the performance of the work involved.

If you have a disability under the Americans with Disability Act or a similar law, and want a reasonable accommodation to assist with your job search or application for employment, please contact us by sending an email to or calling 212-519-1798 . In your email please include a description of the accommodation you are requesting and a description of the position for which you are applying. Only reasonable accommodation requests related to applying for a position within Healthfirst Management Services will be reviewed at the e-mail address and phone number supplied. Thank you for considering a career with Healthfirst Management Services.

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