Director; Enrollment

Director Of EnrollmentLocation: Norfolk, VAWork Shift: First (Days)Overview:The Director of Enrollment is responsible for operational outcomes of the enrollment and billing teams for assigned lines of business (e.g. Medicare, Medicaid, Commercial). Incumbent will act as subject matter expert for the Enrollment and Billing functions of the Operations organization. The incumbent will facilitate the development of enrollment operations on new lines of business and will ensure successful implementations.Technical ProfileCore Enrollment & Billing ExpertiseDeep 834 fluency (not just awareness) Inbound/outbound file structures, reconciliation, error handling, and retroactivityExperience with trading partners, clearinghouses, and CMS/state interfacesStrong understanding of: Eligibility life cycle (prospective ? active ? retro ? term)Premium billing (direct bill, group, subsidy interactions)Coordination with claims (impact of eligibility errors ? downstream rework)Regulatory & Line of Business ExpertiseHands-on experience with at least one: Medicare DSNPMedicaid (state-specific nuances)Commercial (ASO + fully insured)Working knowledge of: CMS enrollment guidance, MARx, TRR processing (for Medicare)State Medicaid eligibility feeds and reconciliation processesAbility to translate regulation to operations to system configurationPlatform & Systems OrientationExperience with core admin platforms (examples to probe for depth, not just name-dropping): Facets, QNXT, HealthRules, or equivalentDemonstrated ownership of: Configuration decisionsEligibility error queuesVendor integrations (ID cards, print/mail, etc.)Operational Analytics & ControlsStrong orientation toward metrics and controls, not just throughput: Enrollment accuracy rateRetroactivity volume834 reject rates / auto-adjudication ratesBilling variance / reconciliation accuracyExperience building: Daily/weekly operational dashboardsAudit controlsImplementation & Transformation ExperienceProven track record in: New line of business launchesSystem migrations or platform conversionsLarge-scale membership growth or M&A integrationKnows how to stand up: Parallel testingFile validation frameworksGo-live stabilization modelsLeadership Profile: What to Screen ForOperational Leadership (Run)Has led teams that manage high-volume, high-accuracy transactional workInstills discipline around: SLAsQuality assuranceFirst-time-right processingStrategic Leadership (Change)Can articulate how enrollment evolves from: Transactional processing to proactive eligibility managementExperience reducing: Call volume driven by eligibility issuesClaims rework driven by enrollment defectsBrings a continuous improvement mindset (Lean, Six Sigma, or equivalent rigor)Cross-Functional InfluenceProven ability to partner with: IT (especially around 834s, EDI, platform configs)Claims (eligibility defect leakage)Customer service (call drivers tied to enrollment errors)Can translate operational issues into financial and member impact languageVendor & Stakeholder ManagementExperience holding vendors accountable: ID card production SLAsPrint/mail timelinesClearinghouse performanceStrong governance discipline (QBRs, SLAs, penalties, etc.)Talent & CultureBuilds teams that: Understand why accuracy matters (not just processing speed)Are resilient during peak cycles (AEP, Medicaid redeterminations)Experience leading through: High-pressure cyclesRegulatory changeAmbiguity during implementationsBachelor's degree required.Previous customer service and management experience required.Benefits: Caring For Your Family and Your Career Medical, Dental, Vision plans Adoption, Fertility and Surrogacy Reimbursement up to $10,000 Paid Time Off and Sick Leave Paid Parental & Family Caregiver Leave Emergency Backup Care Long-Term, Short-Term Disability, and Critical Illness plans Life Insurance 401k/403B with Employer Match Tuition Assistance $5,250/year and discounted educational opportunities through Guild Education Student Debt Pay Down $10,000 Reimbursement for certifications and free access to complete CEUs and professional development Pet Insurance Legal Resources Plan Colleagues have the opportunity to earn an annual discretionary bonus if established system and employee eligibility criteria is met.Sentara Health is an equal opportunity employer and prides itself on the diversity and inclusiveness of its close to an almost 30,000-member workforce. Diversity, inclusion, and belonging is a guiding principle of the organization to ensure its workforce reflects the communities it serves.In support of our mission "to improve health every day," this is a tobacco-free environment.For positions that are available as remote work, Sentara Health employs associates in the following states:Alabama, Delaware, Florida, Georgia, Idaho, Indiana, Kansas, Louisiana, Maine, Maryland, Minnesota, Nebraska, Nevada, New Hampshire, North Carolina, North Dakota, Ohio, Oklahoma, Pennsylvania, South Carolina, South Dakota, Tennessee, Texas, Utah, Virginia, Washington, West Virginia, Wisconsin, and Wyoming.