Health Plan Operations Manager- Remote

at  BoldAge PACE

BE PART OF OUR MISSION!

Are you ready to BE BOLD and make a real impact in healthcare recruitment? Join our fast-growing, national healthcare organization focused on delivering exceptional care through the PACE (Program of All-Inclusive Care for the Elderly) model. We’re all about putting people first—our participants, our employees, and the communities we serve.
We’re looking for a dynamic Health Plan Operations Manager.
Position: Health Plan Operations Specialist
Location: Remote
Job Type: Full-Time

POSITION OVERVIEW

Enrollment and HPO liaison with programs.

MINIMUM EDUCATION REQUIREMENTS:

• Bachelor’s degree in finance, accounting, business management or healthcare administration.
• Master’s degree in business or healthcare administration preferred.

SPECIAL KNOWLEDGE AND/OR SKILLS:

• Strong verbal and written communication and organizational skills.
• Strong understanding of Medicaid and Medicare eligibility and enrollment processes, trends, and best practices and requirements.
• Must possess solid skills with email, Internet, and Microsoft Office, including the use of word processing, spreadsheets, and file maintenance programs.
• Must possess strong organizational and problem-solving skills, including the ability to analyze information, pay attention to detail, take initiative to follow up on transactions, handle multiple priorities with deadlines, and make decisions about information.
• Excellent verbal/written communication, and interpersonal skills, with the ability to build relationships and influence stakeholders.
• Must have a strong ability to analyze processes, enhance them, and provide suggestions.
• Proficiency in data analysis and reporting tools.
• Ability to adapt to a dynamic environment and drive continuous improvement.
• Ability to work independently and be a self-starter.

WORK BACKGROUND/EXPERIENCE:

• Minimum five (5) years in administration or business operations in healthcare, PACE preferred.
• Managed care experience in Medicaid or Medicare is a plus *

PHYSICAL REQUIREMENTS:

• Physical health sufficient to meet the ergonomic standards and demands of the position.

• Responsible for the accurate enrollment and collection of revenue, with responsibilities to include:
• Responsible for the accurate enrollment and disenrollment of participants across all PACE programs for Medicare, Medicaid and self-pay.
• Verify eligibility for PACE program and document within system in compliance with existing procedures including completion of the insurance verification.
• Manage enrollment data and data systems including data transfers and the development and management of systems to meet PACE programmatic requirements.
• Monitor enrollment trends and metrics to inform strategic decisions and optimize processes.
• Collaborate with cross-functional teams to ensure alignment and effective execution of enrollment strategies including working with local programs to ensure eligibility process is understood and that the process to enrollment is performed a participant in a timely manner.
• Research and document state-specific laws and processes related to enrollment and program services and make recommendations to leadership.
• Communicate with State and federal agencies and vendors related to eligibility and enrollment.
• Manage the revenue process for self-pay participants including billing and collection.
• Act as the liaison for health plan operations with local PACE programs, with responsibilities to include:
• Meet with each PACE site to review financial and operational performance.
• Primary point of contact for local Business Operations Manager (BOM) at each PACE site.
• Develop and administer regular training with BOM related to health plan operations and as requested, finance.
• Assist with government relations with respect to our health plan operations and regulatory audits (e.g., 1/3rd financial audit, Part D audits, enrollment data verification, and other health plan related audits).
• Perform data analysis and report development for PACE program performance (operational and financial).
• Assist with identifying and resolving process issues related to interactions and transitions between health plan operations and vendors, programs and/or other national departments.
• Maintains and updates all forms and materials in all digital locations and ensures staff is informed of important changes.
• Supports the development and expansion of health plan operations as needed.
• Perform other duties as assigned.