Health Plan Enrollment Coordinator PACE
About The Position
The PACE Health Plan Enrollment Coordinator manages Medicare and Medicaid eligibility activities for the PACE program. In this role you will facilitate enrollments and disenrollments, maintain accurate data across CMS systems, and monitor Medicaid eligibility and redetermination. managing Part D eligibility and plan-to-plan payments, submitting and reconciling reports. WHO WE ARE With 12 ministries and access points across Indiana and Illinois, Franciscan Health is one of the largest Catholic health care systems in the Midwest. Franciscan Health takes pride in hiring coworkers that provide compassionate, comprehensive care for our patients and the communities we serve. The PACE program's vision statement is to provide unmatched, individualized, and joyful care through teamwork that is worthy of praise so that seniors experience the best quality-of-life in their communities. PACE offers seniors and their families the care, nutrition, rehabilitation, transportation, and supportive services they need to remain healthy so that they can live in their own home. Franciscan is known for our mission of caring. WHAT YOU CAN EXPECT Practice Hours: Monday - Friday, 8:00 a.m. - 5:00 p.m. No Weekends, Evenings, or Holidays Process and monitor Medicaid eligibility, enrollments and redeterminations. Manage Part D eligibility and plan-to-plan payments. Submit and reconcile MMR, DTRR, FIR, and BEQ reports. Coordinate with external vendors, claims adjudication teams, the pharmacy benefit manager (PBM), and pharmacy vendors. Ensure compliance with CMS and state Medicaid guidelines and supports accurate payment, invoicing, and claims processing. Coordinate with internal stakeholders and participants to complete Medicaid redetermination documentation.
Requirements
- Associate's Degree- Healthcare Administration, Business Administration or Related Field- Required
- 3 years- Experience with Medicare and Medicaid enrollment in healthcare or managed care- Required
- 3 years- Experience and proficiency with CMS systems: MARx, ECRS, PCUG- Required
- 3 years- Experience and Strong Microsoft Excel skills for data management- Required
- 3 years- Experience with Detail-oriented job duties requiring strong organizational skills- Required
Nice To Haves
- Bachelor's Degree- Healthcare Administration, Business Administration or Related Field- Preferred
- 1 year- Experience with PACE, MMP or Medicare Advantage Plans- Preferred
- 1 year- Experience with PBM and pharmacy vendor eligibility coordination- Preferred
- 1 year- Experience with Reed and Associates and PDAC processes- Preferred
Responsibilities
- Process and monitor Medicaid eligibility, enrollments and redeterminations.
- Manage Part D eligibility and plan-to-plan payments.
- Submit and reconcile MMR, DTRR, FIR, and BEQ reports.
- Coordinate with external vendors, claims adjudication teams, the pharmacy benefit manager (PBM), and pharmacy vendors.
- Ensure compliance with CMS and state Medicaid guidelines and supports accurate payment, invoicing, and claims processing.
- Coordinate with internal stakeholders and participants to complete Medicaid redetermination documentation.
Benefits
- Franciscan provides eligible employees with comprehensive benefit offerings. Find an overview on the benefit section of our career site, jobs.franciscanhealth.org.
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Industry
Hospitals
Education Level
Associate degree
Number of Employees
5,001-10,000 employees
