What are the responsibilities and job description for the Director; Enrollment position at Sentara Health?
City/State
Norfolk, VA
Work Shift
First (Days)
Overview:
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 Profile:
Core Enrollment & Billing Expertise
Previous Customer Service And Management Experience Required.
Benefits: Caring For Your Family and Your Career
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.
Norfolk, VA
Work Shift
First (Days)
Overview:
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 Profile:
Core Enrollment & Billing Expertise
- Deep 834 fluency (not just awareness)
- Inbound/outbound file structures, reconciliation, error handling, and retroactivity
- Experience with trading partners, clearinghouses, and CMS/state interfaces
- Strong 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)
- Hands-on experience with at least one:
- Medicare DSNP
- Medicaid (state-specific nuances)
- Commercial (ASO fully insured)
- Working knowledge of:
- CMS enrollment guidance, MARx, TRR processing (for Medicare)
- State Medicaid eligibility feeds and reconciliation processes
- Ability to translate regulation to operations to system configuration
- Experience with core admin platforms (examples to probe for depth, not just name-dropping):
- Facets, QNXT, HealthRules, or equivalent
- Demonstrated ownership of:
- Configuration decisions
- Eligibility error queues
- Vendor integrations (ID cards, print/mail, etc.)
- Strong orientation toward metrics and controls, not just throughput:
- Enrollment accuracy rate
- Retroactivity volume
- 834 reject rates / auto-adjudication rates
- Billing variance / reconciliation accuracy
- Experience building:
- Daily/weekly operational dashboards
- Audit controls
- Proven track record in:
- New line of business launches
- System migrations or platform conversions
- Large-scale membership growth or M&A integration
- Knows how to stand up:
- Parallel testing
- File validation frameworks
- Go-live stabilization models
- Leadership Profile: What to Screen For
- Has led teams that manage high-volume, high-accuracy transactional work
- Instills discipline around:
- SLAs
- Quality assurance
- First-time-right processing
- Can articulate how enrollment evolves from:
- Transactional processing to proactive eligibility management
- Experience reducing:
- Call volume driven by eligibility issues
- Claims rework driven by enrollment defects
- Brings a continuous improvement mindset (Lean, Six Sigma, or equivalent rigor)
- Proven 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 language
- Experience holding vendors accountable:
- ID card production SLAs
- Print/mail timelines
- Clearinghouse performance
- Strong governance discipline (QBRs, SLAs, penalties, etc.)
- Builds teams that:
- Understand why accuracy matters (not just processing speed)
- Are resilient during peak cycles (AEP, Medicaid redeterminations)
- Experience leading through:
- High-pressure cycles
- Regulatory change
- Ambiguity during implementations
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.
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.
Salary : $5,250