Billing and Enrollment Supervisor
2 days ago
The Enrollment and Billing Supervisor plays a key role in overseeing the accurate and timely enrollment of members and the efficient generation of billing statements for both individual and corporate accounts. In an HMO setting, this role ensures smooth coordination between internal departments, clients, and partner providers while upholding strict compliance with company policies, regulatory guidelines, and service level commitments. The Supervisor is expected to lead, guide, and mentor the enrollment and billing team to maintain accuracy, timeliness, and exceptional client service.
Key Responsibilities:
• Supervise daily operations related to membership enrollment, policy updates, benefit plan encoding, and billing generation for both corporate and individual clients.
• Validate the accuracy of member records, enrollment data, plan benefits, and billing summaries to ensure all information aligns with client agreements and regulatory standards.
• Oversee the timely issuance of accurate billing statements, including premium adjustments, endorsements, cancellations, and reconciliations.
• Monitor and manage team performance to meet turnaround time (TAT) requirements, service-level agreements (SLAs), and accuracy benchmarks for both enrollment and billing functions.
• Lead the resolution of complex benefit set-up, enrollment or billing discrepancies, working closely with internal teams such as Sales, Claims, Provider Relations, Finance, and IT.
• Ensure compliance with company policies, regulatory requirements, and data privacy laws in the handling of client and member information.
• Assist in the setup and validation of Agreement Benefit Summaries for new products and corporate accounts.
• Coordinate with the Finance Department for payment reconciliation and outstanding billing follow-ups.
• Prepare and submit accurate reports on enrollment statistics, billing performance, and operational efficiency for management review.
• Support internal and external audits by providing accurate documentation and responding to audit-related queries.
• Train and mentor team members on system updates, policy changes, and best practices to promote continuous development and high service quality.
• Act as a point of contact for escalated client concerns relating to enrollment or billing and ensure timely resolution.
Qualifications:
• Bachelor's Degree Graduate preferably, in Business Administration, Finance, Accounting, or a healthcare-related field.
• Minimum of 3 years of experience in enrollment and/or billing operations, preferably within the healthcare or HMO industry.
• Proven experience in supervising teams and managing workloads in a high volume environment.
• Strong understanding of membership systems, billing cycles, healthcare benefit plans, and client contracts.
• Detail-oriented with a strong commitment to data accuracy and compliance.
• Proficient in Microsoft Office applications and familiarity with enrollment or billing software.
• Excellent problem-solving, communication, and leadership skills.
• Knowledge of healthcare regulations, data privacy laws (e.g., Data Privacy Act), and industry best practices
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