SVP of Operations

This position is responsible for management and oversight of several key discipline areas including Enrollment, Billing and Customer Services Operations for Part D.  In addition, will be responsible for managing outside vendor relationships.  Directs implementation and execution of policies and procedures as they relate to Customer Service, and Enrollment Operations.  Strategic planning and resource management.

 Develops, implements and oversees operational processes to ensure maximization of Part D premium revenue methodology, including effective member/premium reconciliation, accurate and timely transaction processing. Develops Standard Operating Procedures and defines process flows to establish monthly revenue reconciliation processes. Develops control plans and charts to monitor enrollment reconciliation efforts.
Monitors plans and distributes periodic reports to division management and functional partners. Ensure accurate and timely administration, coordination, reporting and reconciliation of Enrollment, special statuses and other elements affecting member premiums. Work with the pharmacy benefits management vendor to ensure accurate and timely administration, coordination, reporting and reconciliation of Part D enrollment, pharmacy encounter data, reinsurance and low income subsidy payments; and other health insurance information. Develops and monitors management reports that measure expected service levels, data and processing quality, and production volumes of all operational and revenue components. Increases the organization’s knowledge and understanding of the Part D program requirements through presentations and training materials related to enrollment and premium reconciliation. Contributes to the growth of the Part D line of business by developing, modifying and improving business processes, policies, and target environment as needed. Implements new requirements consistent with CMS requirements. Implements effective and appropriate program communications plans. Monitors relevant state and CMS systems, guidance and notices.
Leads initiatives to communicate changes and modify processes and documentation as needed.Ensures successful internal and external audits by working with operational teams to maintain compliance with regulatory requirements and requirements for financial and operational controls.
Ensures adherence to appropriate processes, methodologies, policies and procedures. Identifies and resolves any issues that may hinder program success.
Serves as the Part D liaison to the Sales and Marketing team, Management and external vendors. Analyzes identified discrepancies, understands discrepancy root cause, and recommends system enhancements to prevent discrepancy in the future.
Other Duties as Assigned.QUALIFICATIONS   

Knowledge of CMS, Enrollment and billing regulations.Experience in Group products, group administrators and senior.

Computer literate, MS Office, Word, Excel, Power Point, Visio, Access, Project, Windows XP, typing skills, data entry, telephones communication.

Must possess a basic understanding of Medicare & Medicaid terminology.  Knowledge of long term care, and commercial health insurance terminology also helpful.

Must be extremely flexible to be able to prioritize multiple work assignments at one time.

Must be able to coordinate and communicate professionally with business areas; demonstrate accountability to completion of tasks and strives to achieve exceptional performance standards.

Must have supervisory experience to be able to mentor officers, managers and staff.



EDUCATION and/or EXPERIENCE

 

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

 

Knowledge of Medicare Part D Product in particular CMS regulations.

 

Knowledge of Facets operating system.