Supervisor, Reconciliation of Health Benefit Exchange Enrollment

Job Summary

The Supervisor of Reconciliation of Health Benefits Exchange (HBEX) Enrollment is responsible for supervising staff that perform the daily reconciliation of the membership data of the HBEX business. The supervisor leads the reconciliation process that ensures enrollment is correct and accounted for. This position identifies variances and escalate to the appropriate parties for root-cause analysis.  This position is responsible for timely explaining and remediating the errors.   

The Supervisor is responsible for the daily and monthly eligibility and financial rate reconciliation processes that ensure the synchronization of QNXT, SAP and CalHeers systems. This position would communicate with cross-functional teams to resolve system challenges and discrepancies. This position will manage the design, development and implementation of process improvement of inbound and outbound file exchanges between Covered California and L.A. Care systems. This position will take an active role in configuration of Medical Payment System and Services (MPSS) related system activities.                                                                                                                                             

The position supervises all aspects of running an efficient team, including hiring, supervising, coaching, training, disciplining, and motivating direct reports to enable them to master the QNXT, SAP and other required databases to ensure accuracy in the produced product.     

Duties

Supervise the analysis and auditing of the daily processed enrollment transactions received from the Health Benefit Exchange. 

Supervise staff , including, but not limited to: monitoring of day to day activities of staff, monitoring of staff performance, mentoring, training, and cross-training of staff, handling of questions or issues, etc. raised by staff, encourage staff to provide recommendations for relevant process and systems enhancements, among others.

Responsible for the daily workflow and leading the work of assigned staff.  This role will mentor, coach, act as a resource and provide feedback on performance of assigned staff.

Oversee the design, development, implementation, and training of staff on the various timesaving reporting tools.  Ensure the accurate reporting and meeting the regulatory requirements.

Review statistics to measure, audit and analyze identified discrepancies with trend and management reports. Supervise the reconciliation process for Premiums, APTC (Advance Premium Tax Credit) and other subsidies HBEX members.

Supervise and ensure accurate processing of enrollment and rate transactions and execution of dunning activities in SAP and QNXT.

Identify discrepancies in QNXT and SAP systems.  Actively participate in User Acceptance Testing (UAT) of any eligibility and dunning related configuration changes affecting SAP and QNXT.

Duties Continued

Facilitate the effective communication with the appropriate cross-functional departments and agencies (L.A. Care, Centers for Medicare and Medicaid Services (CMS), Covered CA and SAP). Supervise the documentation of all reporting requests for audits purposes.

Performs other duties as assigned.

Education Required

Education Preferred

Experience

Required:

At least 5 years’ experience in a technical function utilizing multiple software applications.

At least 3 years of leading staff or supervisor/management experience.

Experience in Healthcare, QNXT, SAP, EDI, and Covered CA.

Skills

Required:

Expert knowledge in databases and report writing, SSIS and SSRS.

Advanced knowledge of and /or data base systems, SQL, Oracle, or Access.

Solid communication skills (oral and written) and strong interpersonal skills required.

Ability to effectively plan system enhancements or new implementations.

Ability to prioritize multiple projects without compromising desired timelines.

High level of independent judgment.

Must be flexible, organized, and able to handle multiple tasks simultaneously.

Strong skills in project management.

Licenses/Certifications Required

Licenses/Certifications Preferred

Required Training

Physical Requirements

Additional Information