Remote Health Plan Specialist

Remote Health Plan Specialist at BoldAge PACE

BoldAge PACE is seeking a Remote Health Plan Specialist to support enrollment operations, eligibility management, revenue cycle processes, compliance activities, and healthcare reporting initiatives. This position plays an important role in ensuring participants receive accurate enrollment support while helping the organization maintain regulatory compliance and financial integrity.

This Remote Health Plan Specialist role fits best as a low-phone healthcare operations position. Team members regularly communicate with local PACE sites, revenue cycle teams, government agencies, vendors, and internal stakeholders. However, most daily responsibilities focus on enrollment management, eligibility verification, discrepancy resolution, reporting, analysis, and operational support rather than continuous phone activity.

Primary responsibilities include managing Medicare, Medicaid, and self-pay participant enrollment activities, validating eligibility information, maintaining supporting documentation, and resolving enrollment discrepancies that affect participant coverage. Specialists review enrollment transactions, troubleshoot rejected files, investigate inconsistencies, and ensure data accuracy across multiple systems.

In addition, team members support revenue cycle operations by coordinating with finance and local program teams to resolve patient liability issues, enrollment gaps, eligibility mismatches, and reimbursement concerns. The role also involves reconciling enrollment information against billing, capitation, and payment records to reduce revenue risks and improve operational performance.

The position requires strong analytical abilities and attention to detail. Specialists perform operational and financial analysis, monitor enrollment trends, develop reports, identify risks, and provide recommendations that improve efficiency and compliance. Team members also help maintain dashboards that track enrollment activity, eligibility status, operational metrics, and revenue performance indicators.

Additional responsibilities include supporting regulatory audits, maintaining audit readiness, researching state-specific eligibility requirements, assisting with policy updates, training site staff, and collaborating across departments to improve enrollment workflows and participant experiences. Specialists also contribute to system enhancements, process improvements, and operational expansion efforts.

Successful candidates typically possess healthcare operations experience, knowledge of Medicare and Medicaid enrollment processes, revenue cycle fundamentals, strong organizational skills, and the ability to manage complex eligibility issues through resolution. Experience with healthcare compliance, reporting, enrollment systems, and multi-state operations may provide additional advantages.

BoldAge PACE offers a mission-driven work environment focused on improving the quality of life for older adults. Employees receive competitive benefits, professional development opportunities, healthcare coverage, retirement savings options, tuition reimbursement, paid time off, and the opportunity to make a meaningful impact through healthcare operations and participant support.