Health Plan AssociateBCSC
Established in 1912 as a haven for elderly immigrants, the Los Angeles Jewish Health has grown to become a leading provider leader of senior care in Los Angeles. Today, LAJHealth serves over 1,000 seniors in residence and 3,500 seniors annually through our in-home and community-based services.
We value our employees! We offer long term employment opportunities with job stability, including supporting and encouraging career growth advancement. We offer Health, Dental and Vision insurance, Paid Time Off, 9 Paid Holidays, 403(b) with Matching Retirement Plan, Life insurance (paid by the company) and a team spirit workplace culture!
The Health Plan Associate's responsibilities are but not limited to:
Under the supervision of the Brandman Centers for Senior Care (BCSC) Health Plan Specialist (HPS), the Health Plan Associate has responsibility for health plan management assistance with data and claims processing generated by BCSC.
- Enter all administrative invoices into Oracle, research and respond to phone call, email and fax inquiries regarding invoice receipt and payment.
- Research and verify claim status on the monthly IBNR.
- Update or add new providers to PCO when needed.
- Prepare manual checks for Executive Director’s signature.
- Record 820 DHCS payment detail on payment spreadsheet monthly.
- Record Medicare payment detail on payment spreadsheet monthly.
- Work pending claims weekly.
- Clear SOC monthly with DHCS.
- Provide monthly census to Peak and JHA Finance.
- Research and take necessary action to resolve Medi-Cal eligibility issues.
- Provide CareKinesis a Part A Stay Status report bi-monthly.
- Prepare bi-annual Outcomes & Quality Measures report.
- Review Capstone audits and schedule meetings with providers.
- Order ID badges for participants and upload the photos to Peak’s FTP site.
- Research and resolve errors on RAPS return files.
- Prepare incoming claims to be sent to Peak PACE Solutions.
- Research statements received by participant to make sure providers have the correct insurance information in order to process claims for payment.
- Research and provide requested information from law office.
- Review in-center encounters to health plan vendor and create reports for submission.
- Assist with providing relevant regulatory reporting.
- Understands fiscal issues and is appropriately involved in meeting budget targets.
- Consistently meets or exceeds BCSC target for productivity.
- Continually seeks better ways for delivering services and communication.
- Continually meets or exceeds BCSC customer services targets.
- Demonstrates respect for and promotes participant right including dignity, self-determination, access to care, confidentiality and independence.
- Effectively collaborates with staff peers and contractors to meet BCSC goals and further success.
- Complies with all policy and procedures of BCSC.
- And other duties as assigned.
Education and Experience
- Degrees and diplomas: High school diploma required. Bachelor’s degree preferred.
- Certificates, licenses: Must have a valid California driver’s license. TB screening and successful completion of a health examination by a health care provider is required for employment.
- Experience: Qualified professional in the field of health plan claims management with demonstrated or potential competence in working with health plan management functions. Five years of experience with at least 2 years supervisory experience. Knowledgeable about senior health care. PACE experience preferred.
- Skills/Aptitudes: Ability to provide care for the frail elderly. Ability to work independently and to lead a interdisciplinary Team. Good organizational and supervisory skills. Ability to handle complex interpersonal situations
- Must be able to read, write, speak, and understand the English language.
- Must possess the ability to make independent decisions when circumstances warrant such action.
- Must possess the ability to deal tactfully with personnel, participants, visitors and the general public.
- Must be knowledgeable of medical terminology, laws, and regulations as they pertain to long‑term care.
- Must possess the ability to work harmoniously with other personnel.
- Must possess the ability to minimize waste of supplies, misuse of equipment, etc.
- Must be able to follow written and oral instructions.
- Be knowledgeable in computers, data input and output.
- Must be able to relate information concerning a participant’s condition.
- Must not pose a direct threat to the health or safety of other individuals in the workplace.