Director of Health Plan Operations
Apply NowCompany: McGregor Foundation
Location: Cleveland, OH 44118
Description:
Looking for a career with a leading care provider?
GREAT! MCGREGOR IS THE PLACE FOR YOU!
Add up your possibilities and opportunities and be part of something extraordinary! Our mission, vision, and values add up to core actions that fulfill community commitment, education, and teamwork.
Recognized as a leader of innovation and high-value services, McGregor is meeting the changing needs of Cleveland's seniors throughout Cuyahoga County as a leading care provider for elders through our residential care services, community-based PACE program that keeps people connected in the community, and our grant-making foundation that supports innovations, workforce development and quality of care in all settings; each providing ways to age well and improve lives!
We meet or exceed area wage and benefit offerings for members of our Care Giving Team, and our goal is to provide a rewarding employment experience for each Team Member.
We are seeking a Director of Health Plan Operations to manage the McGregor Pace participant health plan and related team members.
Responsibilities
Qualifications
McGregor is an Equal Opportunity Employer that recruits and hires qualified candidates without regard to race, religion, sex, sexual orientation, gender identity, age, national origin, ancestry, citizenship, disability, or veteran status.
GREAT! MCGREGOR IS THE PLACE FOR YOU!
Add up your possibilities and opportunities and be part of something extraordinary! Our mission, vision, and values add up to core actions that fulfill community commitment, education, and teamwork.
Recognized as a leader of innovation and high-value services, McGregor is meeting the changing needs of Cleveland's seniors throughout Cuyahoga County as a leading care provider for elders through our residential care services, community-based PACE program that keeps people connected in the community, and our grant-making foundation that supports innovations, workforce development and quality of care in all settings; each providing ways to age well and improve lives!
We meet or exceed area wage and benefit offerings for members of our Care Giving Team, and our goal is to provide a rewarding employment experience for each Team Member.
We are seeking a Director of Health Plan Operations to manage the McGregor Pace participant health plan and related team members.
Responsibilities
- Supervise the PACE Eligibility team to ensure timely processing of all Medicaid applications/renewals as well as accurate Medicare enrollment/reporting for PACE.
- Supervise the Internal Claims and Medical Coding team.
- Oversee the claims adjudication process with the Third-Party Administrator.
- Coordinate all onsite medical trainings and monthly coding audits.
- Facilitate and complete all CMS one-third financial audits.
- Attend all weekly PACE operations meetings.
- Monitor RAPs submission and errors and ensure issues are identified and resolved timely.
- Coordinate annual bi-directional chart review.
- Oversee the Part D compliance activities including ensuring the accurate and timely completion of all regulatory reporting requirements related to Part D compliance.
- Complete the annual Part D bid.
Qualifications
- Bachelor's Degree required.
- Four - Five years of healthcare finance or insurance experience required.
- Supervisory and management experience required.
- Strong verbal and written communication skills required.
- Attention to detail is essential.
McGregor is an Equal Opportunity Employer that recruits and hires qualified candidates without regard to race, religion, sex, sexual orientation, gender identity, age, national origin, ancestry, citizenship, disability, or veteran status.