Manager, Operations-IFB (Hybrid)

The Manager has three areas of leadership responsibility and accountability: Individual and Family Business (IFB) Billing, IFB Enrollment, and IFB Reconciliation. In this capacity, this position also provides consultation and advice to Medica senior leadership and supports Corporate-wide, cross-functional projects relating to these functions. The Manager is accountable for the timely and accurate performance of the transactional operations performed by Medica for these functions. In addition, the Manager oversees of all system and functional audits, ensuring appropriate operational controls are in place and supports audits performed by Medica Internal Audit and regulatory bodies (CMS and DHS).

This position leads each functional area, including the following responsibilities:

• Build and manage day-to-day relationships internally (Sales, Account Management, Legal, Compliance, Benefit Contract Administration, Product, Claims and Call Centers) and externally (vendors and regulators) so that Medica's business needs are met.
• Design, implementation, compliance, review and discontinuation of all policies and procedures related to functional responsibilities.
• Oversight of EBR operations teams to ensure accurate and timely processing of enrollment transactions, reconciliation activity, premium billing, and issue resolution.
• Oversight of the quality controls in place to ensure accuracy (both financial and procedural)
• Support of all system and functional audits as well as supporting audits performed by Medica Internal Audit andregulatory bodies.
• Manage the audit of Banking, Billing, and Eligibility for end-to-end operations audit processing. This audit will be performed by the analysts and reported to Senior Leadership. The manager is responsible for driving results that meet the customer and Medica expectations.
• Organizational Leadership of the IFB Enrollment, Billing, and Reconciliation team (approximately 27 FTEs total)
• Manage project teams as required to respond to identified process and work improvements, corporate initiatives and special projects as assigned.

• Ensures compliance with Federal and State regulations governing exchange and off-exchange membership
• Accountable for communicating proactively with CMS account managers regarding regular performance and maintaining a positive relationship

MinimumQualifications:

• Bachelor's degree, or equivalent experience
• 5 years of experience in health plan operations, banking, billing, financial operations, and/or related field required
• Previous people leadership experience
• Strong business knowledge of operations, healthcare, business processes, systems and enrollment and billing
• Strong organizational and communication skills

PreferredQualifications:

• Working knowledge of the IFB business
• Previous experience communicating with external regulators

Work Location:Hub -

This position is a Hub role, which requires an employee to occasionally come onsite to the designated office - Twin Cities - for applicable heads-up work. Frequency is determined by business need as decided by leadership.

Equal Opportunity Employer/Protected Veterans/Individuals with Disabilities

The contractor will not discharge or in any other manner discriminate against employees or applicants because they have inquired about, discussed, or disclosed their own pay or the pay of another employee or applicant. However, employees who have access to the compensation information of other employees or applicants as a part of their essential job functions cannot disclose the pay of other employees or applicants to individuals who do not otherwise have access to compensation information, unless the disclosure is (a) in response to a formal complaint or charge, (b) in furtherance of an investigation, proceeding, hearing, or action, including an investigation conducted by the employer, or (c) consistent with the contractor's legal duty to furnish information. 41 CFR 60-1.35(c)