Health Plan Operations Manager- Remote

Join BoldAge PACE and Make a Difference! 

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

 Why work with us?

A People First Environment: We make what is important to those we serve important to us.

Make an Impact: Enhance the quality of life for seniors. 

Professional Growth: Access to training and career development.

Competitive Compensation: BoldAge offers a robust benefits package, including medical, dental, paid time off, 401K, life insurance, tuition reimbursement, flexible spending account, and an employee assistance program.

POSITION OVERVIEW

Enrollment and HPO liaison with programs.

Key Responsibilities:

• 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.

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.

BoldAge PACE provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws.