Director; Enrollment

Director; Enrollment Norfolk, VA Job Details Full-time 1 day ago Benefits Health insurance Qualifications Performance dashboard reports Dashboard development Stakeholder engagement Strategic management Internal controls EDI Medicare Operations management Vendor management Customer service Six Sigma methodology implementation Configuration management Team development Quality assurance Bachelor's degree Continuous improvement Team management Centers for Medicare and Medicaid Services (CMS) IT Senior level Cross-functional collaboration Post-merger integration Leadership Stakeholder relationship building Senior leadership Analytics Stakeholder management

Full Job Description Department and Name:

Business & System Integration- Health Plan Physical Location:

Norfolk, VA Location Type:

Remote Employment Status:

Regular-Full time

Shift:

First (Days)

Posted Date:

April 14, 2026 Job 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) Regulatory & Line of Business Expertise 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 Platform & Systems Orientation 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.) Operational Analytics & Controls 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 Implementation & Transformation Experience 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 2)

Leadership Profile:

What to Screen For Operational Leadership (Run) Has led teams that manage high-volume, high-accuracy transactional work Instills discipline around: SLAs Quality assurance First-time-right processing Strategic Leadership (Change) 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) Cross-Functional Influence 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 Vendor & Stakeholder Management Experience holding vendors accountable: ID card production SLAs Print/mail timelines Clearinghouse performance Strong governance discipline (QBRs, SLAs, penalties, etc.) Talent & Culture 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 Bachelor's degree required. Previous customer service and management experience required. About Us Sentara Health, an integrated, not-for-profit health care delivery system, celebrates more than 135 years in pursuit of its mission - "we improve health every day." Sentara is one of the largest health systems in the U.S. Mid-Atlantic and Southeast, and among the top 20 largest not-for-profit integrated health systems in the country, with 34,000 employees, 12 hospitals in Virginia and Northeastern North Carolina including 10 hospitals with the prestigious Magnet® recognition, and the Sentara Health Plans division which serves more than 1 million members in Virginia and Florida. Sentara is recognized nationally for clinical quality and safety, and is strategically focused on innovation and creating an extraordinary health care experience for our patients and members. Sentara was named a Health Quality Innovator of the Year (2024), was recognized by Forbes as "America's Best-In-State Employer" (2024), "Best Employer for Veterans" (2022, 2023), and "Best Employer for Women" (2020), and named to IBM Watson Health's "Top 15 Health Systems" (2021, 2018). Learn more (Opens in a new tab)