Under minimal supervision, participates in the daily operations and analysis of enrollment for all lines of business for the Denver Health Medical Plan. Compiles and analyzes reports for fallout and coordination of benefits, MedImpact, and 834s. Reconciles complex sets of data received in order to validate reporting. Works and collaborates directly with the manager, and other partners such as all levels of management and employees, plan members, external consultants, DHHA, State and Federal entities and other community organizations to improve enrollment process and optimization of systems.
1.Participate in strategic initiatives and operations for the Health Plan Enrollment team.
2.Works independently and with other Managed Care Departments to compile reports, attestations, and other submissions to submit to the State and CMS/HPMS
3.Collaborates with other departments to compile, analyze and ensure the accuracy of data and documentation for internal and external compliance audits
4.Adherence to enrollment processes, policies and procedures.
5.Resolve claim or member access issues related to enrollment and coordination of benefits.
6.Reconciles complex sets of data received from CMS or the State in order to validate reporting, financial reconciliation, and encounter submissions to align with established goals and metrics
7.Actively identifies problems and opportunities for improvement; identifies appropriate solutions and involves other in the implementation process
8.Enhance and validate member enrollment and disenrollment.
9.Partner with other departments to include Claims, Pharmacy, and IS in developing solutions as issues arise.
10.Ensure compliance with all applicable Federal and State rules and regulations, validating contractual enrollment requirements are reflected in plan enrollment system.
11.Monitor and reconcile data including claims, 834, and 820 files for trends and discrepancies, reporting any operational deficiencies to the Manager.
12.Other duties as assigned.
Knowledge, Skills & Abilities
Extensive knowledge of managed care, Medicare, Medicaid and CHP+ eligibility and enrollment requirements, rules, and processes desired.
Knowledge of Federal and Colorado State statutes, legislative initiatives and regulations, as well as Federal, State and local policies.
Ability to develop data requirements and work with operations teams and groups to extract, organize and analyze data and trends.
Ability to define problems: collect data, establish facts and draw valid conclusions to implement solutions.
Skilled in analytical thinking, problem solving, and process improvement.
Critical thinking, strong written and verbal communication skills, and the ability to effectively interact within a team.
Microsoft Office Suite
Proficiency in Health Plan Management Software involving Claims, Enrollment systems, and Government Data Portals. Knowledge of PC applications, specifically Microsoft Office products, and the ability to learn to computer applications.
Bachelor's Degree (Required) Six years of experience may substitute for a Bachelor's degree.
Two years of direct health care experience with a specific emphasis on Government Health Program operations, regulatory issues, policy development, or compliance required.
Location Denver Health Medical Plan
All job applicants for safety-sensitive positions must pass a pre-employment drug test, once a conditional offer of employment has been made.
Denver Health is an integrated, efficient, high-quality academic health care system that is considered a model for the nation. The Denver Health system includes the Rocky Mountain Regional Level I Trauma Center, a 525-bed acute care medical center, Denver's 911 emergency medical response system, 8 family health centers, 15 school-based health centers, the Rocky Mountain Poison and Drug Center, the Denver Public Health Department, an HMO, and The Denver Health Foundation.
As Colorado's primary safety net institution, Denver Health is a mission-driven organization that has provided more than $3.3 billion in care for the uninsured in the last ten years. Denver Health is a leader in performance and quality improvements and remains financially secure, in part, due to its nationally recognized implementation of lean principles in healthcare. Denver Health is a major resource to the community, serving approximately 185,000 individuals and 67,000 children a year.
Located just south of downtown Denver, Denver Health is just minutes away from many of the cultural and recreational activities Denver has to offer.
We strongly support diversity in the workforce and Denver Health is an equal opportunity employer (EOE).
"Denver Health is committed to provide equal treatment and equal employment opportunities to all applicants and employees. Denver Health is an Equal Opportunity Employer and does not discriminate against any employee or applicant for employment because of race, color, sex, age, national origin, religion, sexual orientation, gender identity, status as a veteran, and basis of disability or any other federal, state or local protected class."
Internal Number: 1130
About Denver Health
Take your career to the next level at Denver Health, where we offer a robust benefits package and endless opportunities for growth. Denver Health is a nationally-ranked, locally-trusted, premier healthcare institution located in the heart of Denver, Colorado.Twenty-five percent of all Denver residents, or approximately 150,000 individuals, receive their health care here. We are known as an integrated health care system that encompasses multidisciplinary academic specialties, a community health system, a level I adult trauma center, pediatric emergency and urgent care center home to Denver Public Health and many of the nation’s leaders in medicine.