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Evolent Health Director, Enrollment Operations in Arlington, Virginia

It’s Time For A Change…

Your Future Evolves Here

Evolent Health has a bold mission to change the health of the nation by changing the way health care is delivered. Our pursuit of this mission is the driving power that brings us to work each day. We believe in embracing new ideas, testing ourselves and failing forward. We respect and celebrate individual talents and team wins. We have fun while working hard and Evolenteers often make a difference in everything from scrubs to jeans.

Are we growing? Absolutely. We have seen about 30% average growth over the last three years. Are we recognized? Definitely. We were named one of “Becker’s 150 Great Places to Work in Healthcare” in 2016, 2017, 2018 and 2019 and are proud to be recognized as a leader in driving important Diversity and Inclusion (D&I) efforts: Evolentachieveda 95% score on its first-ever submission to the Human Rights Campaign's Corporate Equality Index; was named on the Best Companies for Women to Advance List 2020 by; and we publish an annualDiversity and Inclusion Annual Report toshare our progress on how we’re building an equitable workplace. We recognize employees that live our values, give back to our communities each year, and are champions for bringing our whole selves to work each day. If you’re looking for a place where your work can be personally and professionally rewarding, don’t just join a company with a mission. Join a mission with a company behind it.

Director of Enrollment Operations

The Director of Enrollment Operations is responsible for accurate and expedient processing of all membership transactions of Medicaid, Medicare Advantage, and Commercial members, ensuring all requirements set by regulators and clients are being met. This includes but may not be limited to: new business set-up, plan benefit changes, rate changes, file loads, modifications to enrollment for existing business, and ensuring operational compliance with all relevant regulatory agencies. The Director is accountable for establishing and maintaining productive relationships with internal departments across Evolent Health and with key client contacts. At times, the Director may be called upon to represent the department in projects or special assignments. He/she is expected to balance the requirements and perspectives of the operation and the project to produce outcomes that are mutually beneficial and meet the needs of the business. The Director of Enrollment Operations is committed to the development of the knowledge and skills of the regulatory unit. This requires ongoing support and supervision of daily activities and deliverables. He/she is expected to establish performance standards and to provide coaching and performance management to ensure the collective success of the team.

Essential Functions

  • Implement, manage and refine business processes required to deliver expected business results.

  • Ensure the timely and accurate delivery and maintenance of new and existing enrollment data, including system set-up, cross-departmental communication, and exception reporting.

  • Manage the processes supporting reconciliation of group and agency enrollment data; report and resolve discrepancies; implement process improvement, as appropriate. Implement short-term staffing plans to ensure anticipated operational requirements are met.

  • Monitor workload fluctuations and adjust staff assignments accordingly.

  • Ensure team has appropriate resources and highlights areas of need to VP for resolution.

  • Ensure the timely and accurate exchange of information/data with relevant stakeholders of the operation.

  • Monitor the work environment and the business operation. Address concerns that may affect the morale and/or operational effectiveness of the group.

  • Participate in cost/benefit analyses of operational changes in support of future business requirements.

  • Regularly track group/departmental costs, ensuring these are managed within budget. Employ cost containment measures while retaining quality and efficient operations and a productive, healthy work environment. Anticipate expenses and identify potential budgetary concerns to VP.

  • Develop and maintain metrics and measurement to support a consistent, informative, and timely management reporting package.

  • Regularly analyze and report on the productivity and effectiveness of the operations in comparison to established performance metrics. Identify areas of improvement and recommend resolution

  • Define roles and accountabilities for staff, within the group and in the context of the broader process/operation in support of cross-functional efforts.

  • Hire for, develop and recognize the experience and knowledge/skills/abilities required for a successful team.

  • Act as a senior resource person for team members in all areas of the work.

  • Assist the team in resolving administrative and routine operational issues as they arise. Serve as point of escalation with internal and external customers as necessary to resolve issues.

  • Promote the use of accepted best practices and innovative strategies.

  • Ensure operational compliance with all relevant regulatory agencies.

  • Ensure operations meet vendor/customer contractual requirements.

  • Keep abreast of changes in requirements.

  • Proactively identify areas of concern or exceptions and promptly notify stakeholders.

Education and Experience

  • Bachelor’s degree or equivalent work experience

  • Five to seven years’ experience including enrollment, premium billing, customer service and Medicaid regulatory experience

  • Health Plan or TPA experience preferred

  • Experience in leading projects

  • Experience managing a large team, spread across multiple locations

  • Strong analytical and problem solving skills - a proven expert at identifying the issue and developing a solution

  • Strong technical acumen: advanced in Microsoft Excel, familiarity with 834 files preferred, experience working in a claims processing platform a plus

Technical requirements:

Currently, Evolent employees work remotely temporarily due to COVID-19. As such, we require that all employees have the following technical capability at their home: High speed internet over 10 MBPS and, specifically for all call center employees, the ability to plug in directly to the home internet router. These at-home technical requirements are subject to change with any scheduled re-opening of our office locations.

Evolent Health is an equal opportunity employer and considers all qualified applicants equally without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, veteran status, or disability status.