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Claims Services Director
4 months ago
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.
**BASIC FUNCTION**: Manages the daily operations for PACE claims adjudication processing, encounter data reporting, and accounts receivable functions.
**ESSENTIAL DUTIES AND RESPONSIBILITIES**:
- System administrator for claims software along with maintain records of contracted rates for vendors.
- Manages the payment processing for contracted and out of network PACE providers.
- Reviews, submits, and corrects both the State and CMS encounter data processing.
- Oversees team members in the Medicare enrollment process, along with validation of State and Medicare payments.
- Assists with developing goals, standards, and objectives that directly support the build out of an internal TPA services team.
- Manages activities related to staffing, including hiring, orienting, evaluating, disciplinary actions, and continuing education initiatives.
- Assists with the development and implementation of policies, procedures, standards and initiatives.
- Monitors budgets, regulatory compliance, contracts, and vendor relations.
**MINIMUM QUALIFICATIONS**:
- Within scope of job, requires critical thinking skills, decisive judgment and the ability to work with mínimal supervision.
- Must be able to work in a fast-paced environment.
**EDUCATION AND/OR EXPERIENCE**:
- Bachelors degree equivalency with 2 years of cumulative experience and 1 year of cumulative leadership experience required OR 4 years of applicable cumulative job specific experience and 1 year of cumulative leadership experience required.
**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
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.
St. Paul’s Senior Services is an Equal Opportunity Employer
