Government Programs Eligibility & Business Office Manager - PACE Elder Care Services

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Date Posted: 10/08/2024

Requisition Number: 8584

Location: CHA East Cambridge Care Center

Work Days: 8:00 - 4:30, M-F

Category: Professional and Management

Department: CHA PACE

Job Type: Full time

Work Shift: Day

Hours/Week: 40.00

Union Name: Non Union

Department Description:

CHA PACE is a Program of All-Inclusive Care for the Elderly (PACE) at Cambridge Health Alliance (CHA). CHA PACE serves adults 55 years and older with chronic medical and/or mental health difficulties with the goals of achieving the highest level of community independence and preventing nursing home placement. CHA PACE's high functioning interdisciplinary team works to fully integrate and coordinate medical and behavioral health care, community resources, and in-home support services.

Job Summary:

The Government Programs Eligibility & Business Office Manager works closely with multiple teams within and outside CHA PACE to ensure clarity, compliance, and exceptional service for PACE enrollees in regards to their access and ongoing eligibility for MassHealth and Medicare. Additionally, this position is responsible for overseeing business office operations, including payment account settlement and enrollment data management.

Serving as an expert in the MassHealth and Medicare enrollment process and regulatory compliance standards, the person in this role works on an interdisciplinary level with our Quality and Compliance, Health Plans Operations, Casework, and Clinical Operations teams in tracking and reporting MassHealth renewals, long-term care conversion, and Medicare enrollment for existing PACE participants who become eligible. They are also responsible for managing any ongoing government program enrollment issues, as well as communicating progress on issue resolution or involuntary disenrollment processes to all necessary stakeholders, including government agencies, PACE staff, program participants and their families, and other relevant care representatives.

Alongside our Health Plans Operations and Finance staff, the person in this role monitors participant self-pay, spend down accounts, and long-term care (LTC) patient payment amounts. When applicable, they are also expected to follow up on any accounts payable issues and monitor LTC vendor invoices for accuracy and resolution.

Qualifications:

• Bachelor's degree in business/healthcare administration or equivalent experience

• Experience in government program operations (Medicare and MassHealth eligibility) highly desired

• Highly organized, excellent written and verbal communication skills, proficient leveraging IT systems to increase overall organizational efficiency and effectiveness

In keeping with federal, state and local laws, Cambridge Health Alliance (CHA) policy forbids employees and associates to discriminate against anyone based on race, religion, color, gender, age, marital status, national origin, sexual orientation, gender identity, veteran status, disability or any other characteristic protected by law. We are committed to establishing and maintaining a workplace free of discrimination. We are fully committed to equal employment opportunity. We will not tolerate unlawful discrimination in the recruitment, hiring, termination, promotion, salary treatment or any other condition of employment or career development. Furthermore, we will not tolerate the use of discriminatory slurs, or other remarks, jokes or conduct, that in the judgment of CHA, encourage or permit an offensive or hostile work environment.

Cambridge Health Alliance brings Care to the People - including your neighbors, friends and family. Our local hospitals and care centers serve our vibrant, diverse communities, and play an integral role in improving health. As passionate advocates for the underserved, we actively partner with our communities to take on challenging public health issues, and conduct important research to help reduce barriers to care. We believe that everyone deserves access to high quality, convenient health care. This is why our employees believe in where they work and why many build long, rewarding careers at CHA.

Healthcare is changing rapidly. CHA has a strategic plan that charts a proactive course for our future. It is built on a vision of equity and excellence for everyone, every time. It also recognizes that our workforce is our most valuable asset and prioritizes competitive salaries, benefits and professional development opportunities for employees. The strategic plan is changing the way we provide care and improving the health and experience of our patients; we are looking for smart, committed, compassionate people who want to be part of making our vision of better health and equity a reality.

At CHA, you can believe in where you work and go home every day knowing you made a difference. Join our team and help us bring Care to the People.