Associate Director, Eligibility Services

SUMMARY
Responsible for the administration of eligibility and payment of approximately $550 million in annual pension (regular & disability) benefits to over 80,000 beneficiaries. Manages and coordinates internal and vendor-contracted operational activities for Eligibility Services to ensure quality, efficiency and effectiveness of operation. Ensures that all pension application processing, payments, records management, compliance audits, and continuing eligibility activities are carried out in compliance with all applicable regulations, including administrative services agreements, the Funds’ administrative policies as well as the Funds’ Plans and Trusts.

Responsible for enrollment/disenrollment of beneficiaries into/from the Funds Medicare Health Care Pre-Payment Plan and for managing the Funds’ relationship with regulator the Centers for Medicare and Medicaid Services (CMS) for this purpose. Ensures that health plan enrollment/disenrollment is executed in an orderly, quality-driven, timely fashion. Ensures that all Eligibility Services programs are operational, and that budget guidelines are met. Assumes the duties of the Deputy Director of Eligibility Services in his/her absence.

PRIMARY DUTIES AND RESPONSIBILITIES include the following. Other duties may be assigned.

• Directs and oversees all activities pertaining to health and pension application processing, to ensure that all vendors and subcontractors perform the services as outlined in the current administrative services agreements and upholds the Funds expectation of excellence. Provides direct support to the Eligibility staff that contributes to the improvement of the quality and production of pension and health applications.
  
• Oversees the eligibility and pension duties within the department. Works closely with eligibility processing and servicing staff to deliver timely payments of pension, disability, and death benefits.
  
• Monitors and reports to Trustees on all program performance measures under the administrative agreements.
  
• Monitors the Funds’ privacy policies and directs department personnel efforts who monitor, implement, and maintain compliance with HIPAA rules and regulations.
  
• Assumes a vital role in the transition of new groups that are enrolled into the health plans due to bankruptcy or through collective bargaining.
  
• Motivates his/hers direct reporting staff, ensuring they clearly understand the Funds’ goals and philosophy.
• Reviews department budget and monitors expenditures. Manages managers and program managers in the department and is responsible for the overall direction, coordination, and evaluation of this department. Carries out managerial responsibilities in accordance with the Funds’ policies and applicable laws.
  
• Responsible for adhering to all Funds’ policies and procedures adopted to comply with the Health Insurance Portability and Accountability Act (HIPAA) governing the privacy, security, and use of protected health information.
  
• Supports the organization’s annual review of Agreed Upon Procedures and beneficiary file comparisons in conjunction with outside auditors and U.S. Department of Interior’s Office of Surface Mining.
  
• Directs all enrollment and eligibility activities related to the Department’s relationship with Medicare (CMS) and the Department of Labor’s Black Lung and Workers’ Compensation Programs. Works with (and directs) the Manager of Beneficiary Enrollments, assuring all Funds programs meet standards of regulatory compliance.
  
• Directs and oversees the Payments function, which results in producing paper check or electronic monthly pension payments to 80,000 payees monthly, plus individual daily standalone and first-time payments. Ensures appropriate procedures and data security. Maintains accurate, safe banking account and address data for payees. Directs the maintenance of individual pension payment records, including direct deposit changes and withholding for federal taxes and union dues. Works with Finance and General Services to ensure payments are made properly and on time.
  
• Directs the credit hours reporting function, receiving classified employment data submitted by signatory employers, uploading data in the FMS system, and coordinating an annual hours verification mailing to active employees.
  
• Manages the Disability Pension Medical Review function, supervising a team of registered nurses who award and deny benefits to disabled coal miners. Manages staff and quality checks each written decision to assure that analyses attain a high level of accuracy, credibility, and consistency to defined standards. Works with the Office of General Counsel to ensure eligibility decisions are legally defensible and appropriate. Ensures expert standards of writing, analysis, and process adherence.
  

SUPERVISORY RESPONSIBILITIES:
Directly supervises several managers of classified staff, totaling 10-15 employees. Carries out supervisory responsibilities in accordance with the Funds' policies, collectively bargained agreements with the employees’ union, and applicable laws. Promotes career development activities for employees. Contributes to succession planning activities. Excellent delegation and prioritization skills are essential.

INDUSTRY KNOWLEDGE:
In-depth knowledge of the administration of eligibility in health and welfare plans, ERISA, COBRA, Qualified Domestic Relations Orders, and appeals, as well as applicable Medicare and Black Lung laws and regulations. General knowledge of process improvement, leadership, and management philosophies.

QUALIFICATIONS
To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Education and/or Experience:
Bachelor's degree (B.A.) from four-year college or university, plus seven or more years related experience and/or training, of which five years should be managerial or supervisory, or equivalent combination of education and experience. MBA or MPA preferred.

Leadership Skills:
Proven ability to lead and manage teams effectively, providing guidance, support, and motivation to achieve objectives. Experience in supervising and developing staff is crucial.

Strategic Thinking:
Demonstrated capability to think strategically and develop long-term plans to enhance operations and drive process improvements. The ability to align strategies with the organization's overall vision is vital.

Communication/Presentation Skills:
Exhibits strong communication and presentation skills combined with the capacity to interact knowledgeably and clearly with a range of internal and external audiences.

Project Management:
Experience in overseeing multiple projects, ensuring deadlines are met, and resources are allocated effectively.

Innovation and Creativity:
Demonstrated ability to bring fresh and innovative ideas to the table, driving continuous improvement and promoting a culture of innovation.

Data Proficiency:
Comfortable working with data and possessing strong data analysis skills.

Language Skills:

• Ability to read, analyze, and interpret general business periodicals, professional journals, technical procedures, or governmental regulations.
  
• Excellent language skills, including the ability to write reports, business correspondence, procedure manuals, business requirements, and technical proposals.
  
• Ability to effectively present information and respond to questions from Funds' staff, attorneys, Union officials, Trustees, Government officials, and beneficiaries.
  

Mathematical & Systems Skills:

• Requires use of basic math (addition, subtraction, multiplication, division, ratios, etc.) on a regular basis.
  
• Advanced ability to understand analysis of large datasets.
  
• Ability to articulate requirements to systems development personnel to develop data queries and to develop data visualizations based upon resultant data that will help department and organizational leadership understand and make actionable decisions
  
• Ability to navigate through system interconnections between various agencies and organizations.
  

Reasoning Ability:

• Ability to define problems, collect data, establish facts, and draw valid conclusions.
  
• Ability to interpret an extensive variety of technical instructions in mathematical or diagram form and deal with several abstract and concrete variables.
  
• Ability to review detailed data and infer big-picture ramifications.