TL-Enrollment & Billing

Job Summary

Serve as a hands on enrollment and billing team lead for a global healthcare client overseeing end to end activities in benefits open enrollment and billing operations under HIPAA compliant processes. Collaborate with payer and provider stakeholders in a hybrid work model with consistent night shift coverage to ensure accurate timely and compliant member transactions.

Responsibilities

• Lead day to day enrollment and billing processing activities to ensure accurate member data capture and timely billing outcomes across payer and provider lines of business.
• Oversee benefits open enrollment tasks by validating eligibility coverage elections and premium calculations to minimize downstream financial and service errors.
• Coordinate with internal payer operations teams to clarify complex benefit rules and ensure that enrollment decisions are applied consistently across plans and member segments.
• Work closely with provider operations teams to align member enrollment records with provider participation data so that claims handling and billing activities remain accurate and efficient.
• Review queued transactions and work items in enrollment and billing systems during the night shift to ensure service level commitments and turnaround timelines are consistently met.
• Analyze enrollment discrepancies and billing exceptions to identify root causes and recommend corrective actions that reduce rework and improve member satisfaction.
• Document operational procedures for enrollment and billing processes to promote standardization knowledge sharing and consistent adherence to HIPAA compliant guidelines.
• Collaborate with compliance and data privacy stakeholders to ensure all enrollment and billing work products align with HIPAA requirements and enterprise security expectations.
• Partner with cross functional teams including customer service claims and finance to resolve complex member or group level billing issues in a proactive and transparent manner.
• Monitor key performance indicators related to benefits enrollment accuracy billing timeliness and error rates to support continuous improvement initiatives.
• Provide clear operational feedback to product and technology teams on system defects usability challenges and enhancement opportunities for enrollment and billing platforms.
• Participate in hybrid model collaboration sessions and virtual meetings during night hours to align work priorities and share insights on payer and provider domain trends.
• Contribute to organization wide initiatives that enhance healthcare affordability and accessibility by ensuring precise enrollment handling and reliable billing information.

Qualifications

• Possess four to five years of experience in healthcare enrollment and billing operations with proven exposure to benefits open enrollment cycles.
• Demonstrate strong working knowledge of HIPAA regulations with the ability to apply privacy and security expectations to daily transaction handling and documentation.
• Exhibit deep understanding of both payer and provider domains including plan structures provider networks and reimbursement implications of enrollment decisions.
• Apply advanced analytical skills to interpret enrollment files premium reports and reconciliation outputs while identifying trends and anomalies.
• Utilize excellent communication skills to interact effectively with global stakeholders across business operations and technology functions in a hybrid environment.
• Show adaptability to consistent night shift schedules with the discipline to manage workloads priorities and personal well being.
• Display familiarity with common healthcare enrollment and billing systems along with proficiency in spreadsheets and basic reporting tools for data validation.
• Maintain a continuous learning mindset by staying current on regulatory changes payer policies and provider contract nuances that influence enrollment outcomes.