Health Plan Specialist

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 communitys 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 BEQs 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:

• Medical and Prescription Drug Coverage: Three comprehensive plan options (Buy-up Base and High Deductible) through UnitedHealthcares Choice Plus network covering various deductibles and out-of-pocket limits. Includes access to telemedicine services via Teladoc.
• Health Savings Account (HSA): Available for employees in the High Deductible Plan with employer contributions and tax advantages.
• Flexible Spending Account (FSA): Options for both healthcare and dependent care FSAs allowing pre-tax contributions for qualified expenses.
• Dental and Vision Coverage: Dental insurance through Cignas DPPO network and vision coverage through EyeMeds Insight network.
• Retirement Plan: Pre-tax and Roth 403(b) retirement plans with a 5% employer match starting after 30 days of employment.
• Life and Disability Insurance: Basic Life and AD&D insurance provided at no cost with the option to purchase additional coverage. Long-term and short-term disability insurance are also available.
• Employee Assistance Program (EAP): Free confidential support for personal and professional challenges including counseling and crisis intervention.
• Additional Voluntary Benefits: Options for critical illness accident hospital care and pet insurance through MetLife.
• Pay on Demand Available.

Holidays:

• Nine paid holidays per year.

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.

Preferred Qualifications

• Associates degree or equivalent direct work experience.
• Administrative experience in a health care setting.
• Experience with health care service contracts and claims payments.
• Understanding of Medicare Advantage Medicaid or Medicare Prescription Drug Plan.
• Working knowledge of Medicare/Medicaid eligibility billing and fee schedules.
• Ability to work in an area with participants and families. Has the ability to multi-task.
• Excellent verbal and written communication skills.