Job Description
Job Description
About One Senior Care
The One Senior Care family of businesses—including LIFE-NWPA, Mountain View PACE, and Buckeye PACE—work together to support seniors in staying safe, healthy, connected, and at home. Our team is dedicated to helping older adults maintain their independence and well-being while remaining part of their homes and communities for as long as possible. We are a premier healthcare provider striving to provide excellent patient care free from the traditional boundaries of medical insurance plans. Our employees consistently hear from our Participants, “I am grateful for you!”
Schedule:
Standard operating hours are 8:00 am – 5:00 pm; Monday-Friday. Specific work hours will be established through discussions with your supervisor.
Benefits:
- 9 Paid Holidays
- 3 Weeks and 1 Day of Paid Time Off Accrued from the Date of Hire for Full-Time Employees
- Medical, Dental, & Vision
- Free Life and AD&D Insurance Plan
- Health Savings and Flexible Spending Accounts
- Short Term Disability Insurance
- Group Voluntary Term Life Insurance for Employee, Spouses, and Dependents
- Paid Parental Leave
- Tuition Reimbursement
- Retirement Plan with Up to 5K Matching Annually / Vesting Schedule (Pre-taxable Savings)
Job Summary:
The Enrollment and Revenue Specialist supports the Program of All-Inclusive Care for the Elderly (PACE) by ensuring accurate, compliant, and timely Medicare and Medicaid enrollment processes. This role is responsible for managing data integrity, coordinating with federal and state systems, and maintaining reporting to support program revenue and reimbursement activities.
Duties/Responsibilities:
- Maintain thorough knowledge of Medicare systems, processes, and regulatory guidelines.
- Manage uploading and downloading of Medicare communications; oversee timely and accurate data entry into federal systems.
- Monitor participant enrollment data for accuracy; research discrepancies and implement corrective action as needed.
- Prepare and maintain accurate reports for Medicare enrollments and disenrollments.
- Serve as Subject Matter Expert (SME) for Medicaid enrollment and disenrollment processes.
- Maintain working knowledge of state Medicaid systems, procedures, and compliance requirements.
- Assist with the preparation, submission, and tracking of Medicaid applications, renewals, and supporting documentation.
- Manage uploading, downloading, and proper dissemination of Medicaid communications.
- Collect, verify, and submit data required for Medicaid applications in coordination with state agencies.
- Act as the primary finance liaison to state Medicaid offices regarding applications and related inquiries.
- Maintain accurate and timely reports for Medicaid enrollments and disenrollments.
- Support other revenue-related functions and special projects as required
Required Skills/Abilities:
- 3+ years of Medicare/Medicaid experience in a Business Office or Social Work Setting
- 3+ years of experience with Federal, State and/or County Communications regarding Medicare Enrollments/Medicaid Applications
- Intermediate knowledge of Microsoft Office Products
- Intermediate Computer skills
Education and Experience:
- High school diploma required; Business or Accounting degree preferred.
Requirements:
- Requires valid State driver’s license with a clean driving record.
- Successful completion of background check, physical, drug screening, TB Screening
Physical Requirements:
- Prolonged periods sitting at a desk and working on a computer.
- Must be able to lift to 15 pounds at times.
- Must be able to access various departments of a given location.
Our organizations provide equal employment opportunities to all employees and applicants for employment. It prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state, or local laws.
The OSC family of businesses will only hire qualified individuals to work in a federally funded healthcare program. Please note that this excludes anyone convicted of a crime that could jeopardize the safety and well-being of the frail senior population that OSC/BP/LIFE-NWPA/MVP serves. All individuals must disclose any conflicts of interest upon applying for a position and agree to a thorough background check when an employment offer is extended.
Employment Requirements: Successful completion Criminal History Check, Office of Inspector General check, and FBI Fingerprinting for Child Protective Services Law (at employer’s expense). Successful completion of post-offer employment drug screening and physical (at employer’s expense). CPR and First Aid Certification, or willing to obtain at employer’s expense. Individuals must have one year of prior experience caring for the frail elderly or willing to complete Company paid training to meet this requirement.
This position has full access to Participant, program, and staff records and reports, requiring discretion to protect individuals and the program.