PACE Benefit Enrollment Specialist

For more than 55 years, Family Health Centers of San Diego’s (FHCSD) mission has been to provide caring, affordable, high-quality health care and supportive services to everyone, with a special commitment to uninsured, low-income and medically underserved persons.

FHCSD is one of the top 10 largest federally qualified health centers (FQHCs) in the country. We operate more than 90 sites across San Diego County, including 29 primary care clinics, 23 behavioral health facilities, 10 physical rehabilitation clinics, nine dental clinics, five vision clinics, four outpatient substance use treatment programs, three mobile medical units, two mobile counseling centers, two urgent care centers, and a pharmacy.

Our staff provides care to over 227,000 patients each year, of whom 91% are low-income and 29% are uninsured. FHCSD provides care to all. Services include, but are not limited to adult care, chronic disease management, pediatrics, comprehensive women’s care including obstetrics, dental, vision, case management, physical rehabilitation, speech therapy for children, vaccinations, infectious diseases, behavioral health, substance use counseling and a host of specialty services including cardiology, podiatry, endocrinology, dermatology, among others.  FHCSD also offers supportive services to those who are unsheltered and in need of intensive case management.   

The breadth of our clinic locations, services and programs has grown over the last five decades, making us the largest community clinic provider of health care to the uninsured in the county and one of the top 10 largest community clinic organizations in the nation. We are also the largest health care safety-net provider, largest school-based health care provider and the largest mental health provider in the San Diego region.

Job Roles

• Review, assess, and evaluate health plan coverage of potential PACE Participants.
• Obtain insurance information to verify and validate coverage to determine allowable benefits.
• Analyze specifics of each health plan coverage related to Medicare, Medicare Advantage, Medicare Part D, Medi-Cal, private insurance, etc.
• Determine the calculated amount and timing of asset levels for Medi-Cal qualification.
• Explain, clarify, and define allowable parameters related to the PACE Program guidelines and regulatory Benefit Plan requirements.
• Explain, clarify, and provide possible recommendations, based on PACE Program guidelines and regulatory requirements in determining out-of-pocket costs.
• Ensure all questions and possible scenarios are covered and understood by all affected parties.
• Preserve confidentiality of all information collected and analyzed.
• Maintain meticulous records and information to ensure accuracy and completeness in developing outcome reports.
• Perform other duties as assigned.

Requirements:

• Bachelor’s Degree in Business Administration or closely related field required.
• OR equivalent combination of education and experience that provides the skills, knowledge and ability to perform the essential job duties.
• Ability and means to travel as needed in a timely manner within San Diego County, to locations that may have limited access to public transportation; proof of liability and property damage insurance on vehicle used is required. DRIVER REQUIREMENTS: Licensed for a minimum of 3 years; No more than 2 violations and/or accidents within 3 years; No vehicle related suspensions/reinstatements; No DUI, reckless or felony Driving within 7 years.

Experience/Specialized skills (including Language)

• 2 years of experience reviewing, evaluating, analyzing, or administering private and/or government-related healthcare benefit plans and programs.
• Strong analytical and problem solving skills.
• Possess critical thinking skills.
• Good understanding of private and/or government-related healthcare benefit plans and programs.
• Ability to multi-task, be flexible, ensure accuracy, and meet changing priorities in a fast-paced, high-workload environment.
• Demonstrated ability to capture, analyze, and interpret a wide array of data and information.
• Strong verbal and written communication skills to include the ability to interact with people in a variety of situations.
• Proficient level of experience with Microsoft Office applications to include Word, Excel, etc.
• Strong organizational skills, attention to detail, time-management skills, and strong motivation to meet deadlines and achieve goals.

We are excited to share that the salary range for this position is:

22.00 - 30.535

Information on our extensive benefits package can be found here: FHCSD Wellness – Employee Hub (gobenefits.net)

FHCSD provides Equal Employment Opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state, or local laws. This policy applies to all terms and conditions of employment, including recruiting, hiring, placement, promotion, termination, transfer, leave of absence, compensation, and training.