Enrollment & Billing Manager
A mission‑driven, fast‑growing virtual‑first health plan is seeking an experienced Manager of Enrollment & Billing to serve as the subject‑matter expert for ACA Marketplace operations. This is a highly visible role with end‑to‑end ownership of enrollment and premium billing, sitting at the intersection of revenue, compliance, systems, and member experience.
This opportunity is ideal for someone who has lived inside ACA enrollment and billing, understands how accuracy impacts both members and the company's financial health, and wants to lead and improve these processes as the organization scales.
What You'll Own
- Lead ACA Marketplace enrollment and billing operations end to end, including OEP and SEP execution
- Own premium billing, payment application, subsidy reconciliation, and revenue integrity
- Ensure accurate processing of new enrollments, renewals, terminations, invoicing, credits, and refunds
- Serve as the internal expert on CMS and state exchange data files (EDI 834/820, RCNI/RCNO, MMR, DTRR, pre‑audit files)
- Drive reconciliation between internal systems, CMS, and state marketplaces
- Develop KPIs, monitor performance, and resolve discrepancies and root‑cause issues
- Lead enrollment‑related audits, including risk adjustment and regulatory reviews
- Partner closely with Technology to improve and scale a proprietary enrollment platform
- Coordinate eligibility and billing accuracy across downstream systems (claims, PBM, dental, vision, UM/CM, etc.)
- Identify automation opportunities and build audit‑ready, scalable processes
What We're Looking For
Required:
- 7+ years of experience within a health plan, with deep focus on ACA Marketplace operations
- Strong hands‑on experience with enrollment, billing, and subsidy reconciliation
- Expert‑level understanding of CMS enrollment and payment processes and files
- 3+ years of leadership experience in a high‑volume operational environment
- Proven ability to lead through ambiguity in a growing or transforming organization
Preferred:
- Experience defining requirements for internally built enrollment platforms
- Strong analytical and root‑cause problem‑solving skills
- Advanced Excel skills and comfort using BI or data visualization tools
- Ability to clearly translate complex regulatory requirements into actionable workflows
Why This Role
- True ownership of a mission‑critical function
- Direct impact on affordability, access to care, and member experience
- Opportunity to shape systems and processes in a growing health plan
- Collaborative, mission‑driven culture focused on improving healthcare outcomes
- Competitive compensation and benefits
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