Health Plan Manager

Health Plan Manager Department(s): PACE Finance Reports to: Executive Director FLSA status: Non-Exempt EEOC Classification: Professionals Job Summary The Health Plan Manager at AgeWell PACE oversees the administration and management of health plan services, ensuring compliance with regulatory standards and high-quality care delivery. This role involves PACE strategic planning, operational management, and continuous improvement to meet the needs of elderly participants effectively. The Health Plan Manager collaborates with interdisciplinary teams to develop personalized care plans, monitors participant outcomes, and leads quality assurance initiatives. Position Responsibilities § Process and verify claims for accuracy, ensure compliance, correct errors, and stay updated on standards. § Resolve claims errors, interpret contract terms, and ensure accurate application in claims processing. § Process enrollments and disenrollments for Medicare and/or Medi-Cal eligible enrollees to the respective Regulatory agencies. § Maintain communication with external and internal audiences, understand claim contracts, and address queries. § Coordinate submission of reports to appropriate regulatory agencies, including CMS, HPMS, and DHCS as assigned. § Understand and communicate payment terms and provide guidance on complex clauses to internal teams. § Assist in preparing documentation, analyzing financial impact of regulatory changes, and present findings. § Manage the closing process for Medicare and Medi-Cal payments, ensuring accuracy and timeliness. § Support preparation of reports, analyze data for insights, and provide recommendations. § Collaborate on invoice billing, conduct cost analysis, and ensure accurate financial reporting. § Prepare detailed cost reports, ensure compliance with regulations, and gather supporting documentation. § Perform other assigned tasks, improve processes, and stay informed about industry trends and changes. § Assist supervisor to review and comment on health plan policies and procedures. Possess the Ability To § Work independently and as an effective member of the team. § Establish and maintain effective interpersonal relationships with teams’ staff, other programs, agencies, members, and the general public. § Communicate effectively, both verbally and in writing, with individuals from varying cultural backgrounds. § Effectively use computer to process appropriate data and information and prepare reports. § Effectively utilize computer and appropriate software and interact as needed with AgeWell PACE Information Systems. Experience & Education § Bachelor’s degree from an accredited university. § At least 3 years’ experience in medical billing and coding. § Exercise sound judgement, problem-solving skills and meet deadlines. § Detail oriented, with strong multi-tasking skills. § Excellent writing, proofreading, and editing skills. § Proficient with software including Microsoft Word, Excel, and Outlook, ICD10 and CPT Coding systems. § Experience working in healthcare nonprofit organization, strongly preferred. § Knowledge and experience in project management, data collection, statistical analysis and preparation of reports preferred. § Flexibility, creativity and ability to work with an ethnically diverse group of clients and employees. Physical Demands and Work Environment The physical demands and work environment characteristics described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. § Physical demands: Employee must be able to sit for extended periods of time. Employee will also be actively present throughout the PACE center, engaged with employees, participants and with staff. Employee is required to use hands and fingers, especially for typing on the computer and using the mouse. Employee must be able to talk and hear, particularly for daily interactions with staff and elderly participants. § Work Environment: Employee must be able to work in a busy and demanding clinic environment with moderate to loud noise levels. The Job duties, elements, responsibilities, skills, functions, experience, educational factors and the requirements and conditions listed in this job description are representative only and not exhaustive of the tasks that an employee may be required to perform. The Employer reserves the right to revise this job description at any time and to require employees to perform other tasks as circumstances or conditions of its business, competitive considerations, or work environment change. Job Type: Full-time Pay: $33.00 - $38.00 per hour Expected hours: 40 per week Benefits: 403(b) 403(b) matching Dental insurance Health insurance Life insurance Paid time off Tuition reimbursement Vision insurance Medical Specialty: Geriatrics Home Health Schedule: 8 hour shift Monday to Friday Experience: Medical billing: 3 years (Preferred) Processing Medicare/Medi-Cal payments: 1 year (Required) Invoice Billing: 1 year (Required) Capitated Payment Models: 1 year (Required) Ability to Commute: Rohnert Park, CA 94928 (Preferred) Work Location: In person