Health Plan Specialist

Job Description

Job Description

Description :

About Jordan Valley Community Health Center :

Jordan Valley Community Health Center (JVCHC) is a mission-driven organization dedicated to improving the health of individuals and families in underserved communities. We provide comprehensive healthcare services including primary medical, dental, vision, and behavioral health. Our mission is simple : Improve our community’s health through access and relationships. By working collaboratively with partners and continually innovating, JVCHC strives to be a leader in providing essential healthcare for the underserved, ensuring everyone in our community has access to quality healthcare.

Job Summary :

Acts as liaison with State Medicaid Department, Centers for Medicare and Medicaid Services (CMS), the National PACE Association, Pharmacy Benefit Managers (PBM) and third party administrators for matters relating to PACE program data and financial reporting.

Key Responsibilities :

• Run BEQ’s for potential enrollees, review Emomed twice monthly for updates and changes
• Manage enrollment data and data systems
• Collaborates with social workers to ensure participants achieve and maintain Medicaid eligibility.
• Track annual review Dates
• Monthly enrollment data verification (EDV)
• Monthly spend down tracking
• Expense card management and utility payment management and tracking
• Oversee conversions to long term care / report End Stage Renal Disease.
• Oversee claims processing in collaboration with a third party administrator (TPA), pharmacy benefit manager (PBM) serving as lead liaison with TPA and PBM
• Review pre-check register for approval
• Work in conjunction with PACE Finance and consultants to complete annual Medicare Part D Bid Process
• Collaborates with PACE center management on establishing annual budget
• Ensure costs are in correct categories and going through Purchasing policies
• PDAC reporting
• MERCER bi-annual reporting
• HPMS quarterly financial reports
• Encounter Data, RAPS submission
• Coordinate with Finance and FP&A staff
• Stay updated on HPMS memos
• Rate updates by State and Federal agencies
• Communication with PACE Center Staff and review alignment of care plan and financial assistance
• All other duties as assigned.

Benefits Overview :

Holidays :

Health Requirements :

All employees are required to provide proof of vaccination for Flu, Hepatitis B and Tuberculosis (TB) as part of our commitment to maintaining a safe and healthy workplace.

Application Process :

Interested applicants should submit a resume and cover letter through the JVCHC career portal at Careers & Education - Jordan Valley. Applications will be accepted on a rolling basis until the position is filled.

Jordan Valley Community Health Center is an equal opportunity employer. All applicants will be considered for employment without attention to race, color, religion, sex, sexual orientation, gender identity, national origin, veteran, or disability status.

Requirements :

Preferred Qualifications