About Us
Community health is about more than just vaccines and checkups. It’s about giving people the resources they need to live their best lives. At Neighborhood, this is our vision. A community where everyone is healthy and happy. We’re with you every step of the way, with the care you need for each of life’s chapters. At Neighborhood, we are Better Together.
Neighborhood Healthcare PACE is a managed medical plan built around surrounding participants with a team of physicians, nurses, social workers, therapists and care coordinators to help them maintain good health and a good quality of life. Our goal is to keep our seniors happy and healthy at home surrounded by their family and community.
As a private, non-profit 501(C) (3) community health organization, we serve over 500k medical, dental, and behavioral health visits from more than 90k people annually. With two PACE centers located in Riverside County, our PACE program is positioned to serve over 650 senior participants.
ROLE OVERVIEW and PURPOSE
The PACE Enrollment Analyst is responsible for the accurate and timely enrollment submissions for participants into the Neighborhood Healthcare PACE (Program of All Inclusive Care for the Elderly) program. They will work closely with DHCS and CMS to verify eligibility, submit enrollments and disenrollments, and continuously monitor and resolve any discrepancies. This position will record and reconcile all enrollment submissions and demographics to ensure both internal departments and external parties have accurate and timely information. In addition, this role will provide support to the PACE Finance Team as needed.
**9/80 work schedule . Somewhat flex with start time between 7:00 a.m.-8:00 a.m. with a 30 or 60 minute lunch.
RESPONSIBILITIES
- Collaborates with our Outreach Team to gather all needed documentation to accurately enroll/disenroll our participants with DHCS and CMS
- Conducts initial and monthly eligibility checks in Medi-Cal and Medicare to verify eligibility of all participants
- Notifies the team of any changes in eligibility and makes any necessary corrections
- Retrieves and reviews all daily reports from CMS and DHCS to monitor enrollment/disenrollment making any necessary modifications promptly
- Maintains accurate PACE participant demographics and prepares statistical reports for internal departments and external parties
- Reconciles participant stats on invoices received, working with vendors to correct the enrollment information
- Works with our Third-Party Administrator (TPA) and in our Electronic Health Records (EHR) to ensure all enrollment data and participant demographics are accurate
- Works with our Pharmacy Benefit Manager (PBM) on multiple reports and reconciliations including FIR, TROOP, MSPCOB and PDE rejections
- Works closely with the PACE Senior Accountant on all participant enrollment stats and MMR reports to ensure DHCS and CMS have accurate information so they can release payments
- Maintains accurate and thorough records of all activities
- Collaborates with our Redetermination Eligibility Specialist to confirm participants’ eligibility and re-enrollment in Medi-Cal
- Assists the PACE Finance Team with reports and reconciliations as needed
EDUCATION/EXPERIENCE
- 3 years’ experience with submitting enrollment for a PACE program, a federally qualified health center or other community-based public health clinics preferred
- Prior experience with MARx and the Medi-Cal Provider portal preferred
- Knowledge of Medicaid, Medicare and PACE regulations for eligibility and enrollment preferred
ADDITIONAL QUALIFICATIONS (Knowledge, Skills, and Abilities)
- Proficient in Microsoft Excel, Word, Outlook, and Teams
- Ability to successfully manage multiple tasks simultaneously
- Excellent planning and organizational ability
- Ability to work as part of a team as well as independently
- Ability to exercise discretion and independent judgment
- Ability to work with highly confidential information in a professional and ethical manner
- Ability to interpret a variety of instructions in written, oral, diagram, or schedule form.
- Excellent verbal and written communication skills, including composition, typing, and proofreading skills.
COMPLIANCE (Safety & HIPPA)
- Follow all safety procedures as outlined in Neighborhood Healthcare’s Illness and Injury Prevention Plan (IIPP) and report any injuries and/or unsafe conditions immediately.
- Maintains current knowledge of policies and procedures as they relate to safe work practices.
- Follows all safety procedures and report unsafe conditions
- Uses appropriate body mechanics to ensure an injury free environment
- Familiarity with location of nearest fire extinguisher and emergency exits
- Follows all infection control procedures including blood-borne pathogen protocols
- Maintains privacy of all patients, employee and volunteer information and access such information only on a need-to-know basis for business purposes
- Complies with all regulations regarding corporate integrity and security obligations
- Reports all behavior and/or activity that are unethical, fraudulent, or unlawful
Neighborhood Healthcare offers a generous benefit plan that includes: Partially company paid Medical, Dental, and Vision Plans. Two plus weeks of vacation, Nine Holidays including two Floating Holidays of your choosing, Sick/Personal time, Volunteer Time Off (VTO), 403b Retirement plan (similar to a 401k), optional Health and Wellness events, and much more!
Pay range: $70,100.00-$ 81,900.00 annually, depending on experience. Exempt position.
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