VP of Group Operations

This position is responsible for ensuring positive relationships with Group clients including, Brokers, TPA’s, and employer groups.  Managing the overall activities of Group insurance processing for Medicare enrollment, billing and group member reconciliation to includes new client/program set-up, systems evaluation for special processing requests, interfacing with internal and external clients and liaison to group insurance administrators for ongoing operational processing. Responsible for managing and ensuring a successful implementation of external vendor systems and appropriate interfaces with systems. (only related to group specific items)

Responsible for managing the implementation of Group Medicare regulations and related products.

 

 

ESSENTIAL DUTIES AND RESPONSIBILITIES include the following. Other duties may be assigned.

 Reviews and manages the productions of  all written communication and formal reports to all clients and management.Leads, participates and monitors conference calls with group administrators, TPA representatives, other business areas; Ensures client service managers respond within 24 hours to individual client calls. Monitors CMS communication daily to stay abreast of topics, events, conferences, seminars and training opportunities.Coordinates implementation of new employer groups by communicating client requests with internal business areas to finalize client contracts and process new member enrollment files. Responsible for managing the implementation of GROUP Medicare regulations and related products. Act as department's liaison internally and externally in all matter affecting the Medicare Retiree Drug Subsidy (RDS) and/or an Employer's Wrap around program of Medicare Part D and other Group business such as State Pharmaceutical Assistance Programs. Manage the overall activities of the Group processed Memberships,  including enrollment, billing, statistical reporting, Direct pay, COBRA, Membership reconciliations, Commercial group accounts, other Membership and Accounting related system issues. Meet with high-level internal and external executives from client organizations and governmental agencies to resolve problems and implement new programs.

 

QUALIFICATIONS 

 Experience in Group products, group administrators and Group processes.Knowledge of CMS, Enrollment and billing regulations with emphasis on Group.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 regulations.  Knowledge of long term care, and commercial health insurance terminology preferred. Must be extremely flexible to be able to prioritize multiple work assignments at one time. Must be able to coordinate and communicate professionally with other  business areas; demonstrate accountability to completion of tasks and strives to achieve exceptional performance standards. Must make the client needs a primary focus of one’s actions; develop and sustain productive client relationships. Must have supervisory experience to be able to mentor billing analysts and client service managers.

 EDUCATION and/or EXPERIENCE

 

Must have 5 years experience with groups.  Bachelor's degree from four-year college or university; or five years related experience and/or training; or equivalent combination of education and experience.