Job description

St. Paul’s Senior Services is excited to announce an amazing opportunity to be part of San Diego’s St. Paul's PACE program (Program of All-Inclusive Care for the Elderly). This innovative program is for individuals 55 years or older, who are living with chronic illness, or disabilities and need coordinated medical care to continue living as independently as possible in their home and community.

The healthcare teams at St. Paul’s PACE provide a hands-on approach coordinating medical, social, and home care services so individuals no longer need to manage their medical care alone. Job Summary: Responsible for the daily functions of St. Paul's PACE Health Plan insurance related duties for all sites of the St.

Paul’s PACE program. Provides customer service as the point of contact for all incoming Health Plan related inquiries from contracted providers, vendors and participants. Coordinates with Finance department, contracted service providers, and our TPA vendor to ensure provider billing adjudication is completed including incoming appeals, accurate authorization and verification process, ICD-10 Code submission and timely claims processing. Ensures compliance with all Medicare and Medi-Cal health plan regulations and directives, including Part D Fraud, Waste and Abuse (FWA).

Assists with encounter data collection, tracking, and reporting to State, Centers for Medicare & Medicaid Service (CMS), local licensing agencies, and California PACE Association. Qualification and Requirements • Education: Associate’s degree (AA) or equivalent from a two-year college or technical school, bachelor degree preferred, or equivalent combination of education and experience. • Experience: One or more years’ experience with health insurance and health information related activities in a healthcare work environment or two years of administrative and/or billing/claims support experience St. Paul’s Benefits: • Health, dental, vision, life • Same day pay available!

• Flexible paid time off (PTO) - starting at 28 days per year! • Education reimbursement - up to $3,000 a year! • Qualified Public Student Loan Forgiveness (PSLF) employer • 403(b) with match • Child care available • Employee referral bonuses • Upward mobility! St.

Paul’s is committed to protecting our employees and our seniors from COVID-19. As such, and in compliance with the California Department of Public Health, St. Paul’s mandates that all newly hired employees be vaccinated, and boosted, to prevent COVID-19. If you cannot vaccinate due to medical and/or religious reasons, please contact our HR Department.

You Make Us Who We Are! At St. Paul’s Senior Services, we believe a diverse workforce has driven our history of enriching the lives of senior communities in San Diego, which is why we are committed to cultivating an environment where you feel empowered, supported and respected. By valuing your unique perspective, voice, strengths, experience and background, we aim to foster a culture where you feel included and comfortable being your true self.

You matter! St. Paul's is the leading provider of caring senior services since 1960. We have locations throughout San Diego County including 5 in San Diego (Bankers Hill), 2 in Chula Vista, and 1 in El Cajon.

St. Paul's strives to be the most outstanding and innovative senior home and service provider in California. We are dedicated to serving the physical, spiritual and social needs of the elderly and community, fostering a culture of diversity and inclusion within the highest quality facilities, health care and programs consistent with affordable costs. YOU MUST BE ABLE TO CLEAR FINGERPRINTS THROUGH DOJ AND FBI IN ADDITION TO A DRUG SCREEN CLEARANCE.

To learn more about St. Paul’s Senior Services, please visit www.stpaulseniors.org. St. Paul’s Senior Services is an Equal Opportunity Employer

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