Government Programs Eligibility & Business Office Manager - PACE Elder Care Services

Cambridge Health Alliance; Cambridge (MA); On-site; USD 70,000 - 90,000; Full time

Job summary

A leading healthcare organization in Cambridge is seeking a Government Programs Eligibility & Business Office Manager. This role involves overseeing enrollment in government programs like MassHealth and Medicare, ensuring compliance and accuracy in business office functions. The ideal candidate will have a background in healthcare administration and experience with government program operations, along with strong organizational and communication skills.

Qualifications

• Experience in government program operations (Medicare and MassHealth eligibility) highly desired.
• Proficient leveraging IT systems to increase overall organizational efficiency.

Responsibilities

• Serve as CHA PACE’s expert in Medicare and MassHealth enrollment.
• Manage business office functions including enrollment data accuracy and payment account reconciliation.
• Ensure timely communication regarding enrollment issues with stakeholders.

Skills

Organizational Skills

Communication

Education

Bachelor's degree in business/healthcare administration

Job description

Location:CHA East Cambridge Care Center

Work Days:8:00am - 4:30pm, Monday - Friday

Category:Professional and Management

Department:CHA PACE

Job Type: Full time

Work Shift: Day

Hours/Week: 40.00

Union Name: Non Union

About CHA PACE:

CHA PACE is a Program of All-Inclusive Care for the Elderly (PACE) at Cambridge Health Alliance. Our mission is to serve adults aged 55 and older with chronic medical and/or mental health difficulties, aiming to achieve the highest level of independence within the community and prevent nursing home placement. We work as a collaborative and high-functioning interdisciplinary team to provide fully integrated medical and behavioral health care, community resources, and in-home support services.

Job Purpose:

The Government Programs Eligibility & Business Office Managerplays acritical role in ensuring the accuracy and continuity of PACE participants' enrollment in government programs such as MassHealth and Medicare, while also overseeing the business office functions related to eligibility, enrollment, and financial reconciliation.

Key Responsibilities:

•Serve as CHA PACE’s expert in Medicare and MassHealth enrollment, eligibility requirements, and regulatory compliance standards.

•Collaborate on an interdisciplinary level with our Quality and Compliance, Health Plans Operations, Clinical Operations, and Case Management teams to track and manage MassHealth renewals, long-term care conversions, and Medicare eligibility transitions.

•Ensure timely and accurate communication regarding enrollment issues and resolution efforts with government agencies, participants, family members, care representatives, and internal stakeholders.

•Manage business office functions including enrollment data accuracy, payment account reconciliation, participant self-pay tracking, and long-term care (LTC) patient payment oversight.

•Partner with Health Plans Operations and Finance teams to monitor and resolve issues related to spend-down accounts, vendor invoices, and accounts payable, ensuring financial integrity and compliance.

•Support the involuntary disenrollment process when required, with a focus on transparency, regulatory adherence, and stakeholder coordination.

Qualifications:

•Bachelor's degree in business/healthcare administration or equivalent experience
•Experience in government program operations (Medicare and MassHealth eligibility) highly desired
•Highly organized, excellent written and verbal communication skills, proficient leveraging IT systems to increase overall organizational efficiency and effectiveness

In keeping with federal, state and local laws, Cambridge Health Alliance (CHA) policy forbids employees and associates to discriminate against anyone based on race, religion, color, gender, age, marital status, national origin, sexual orientation, gender identity, veteran status, disability or any other characteristic protected by law. We are committed to establishing and maintaining a workplace free of discrimination. We are fully committed to equal employment opportunity. We will not tolerate unlawful discrimination in the recruitment, hiring, termination, promotion, salary treatment or any other condition of employment or career development. Furthermore, we will not tolerate the use of discriminatory slurs, or other remarks, jokes or conduct, that in the judgment of CHA, encourage or permit an offensive or hostile work environment.