Abrar Admin

AllCare Management Services

<div><div><div><div><div><div><div><div><div><div><div>Job Description</div><div><div><div><div><div><div><div><div><div>
Director of Medicare Advantage at AllCare Health with the Marketing Department- in Grants Pass, Oregon</div></div></div><div><div><div><div> 
We Are Seeking Qualified Candidates to Join Our Team!
AllCare Health offers competitive wages, an excellent benefits package including affordable healthcare, 401k retirement, wellness programs, and flexible schedule options. 
Summary of the position
 The Program Director is responsible for the mechanical and financial integrity of our Medicare Advantage (MA) line of business. This role focuses on the back-end systems that drive the program: the annual bid process, Star ratings, risk adjustment data flow, and the accuracy of our clinical documentation. You will ensure our data is audit-proof and that our financial performance matches our strategic goals, while also identifying the opportunities we need to grow our market share. 
Essential Duties
1. The MA Bid: Direct the cross-functional effort to complete and submit the annual bids.
2. Risk Adjustment Operations: You will be responsible for the accuracy of our coding data and ensure that every diagnosis is backed by clinical evidence in the record.
3. Data &amp; Incentive Oversight: Manage the quantification and processing of provider incentive payments. You will oversee specialists analyzing data extracts to ensure accurate, timely payouts.
4. Audit Readiness: Maintain a continuous state of audit readiness for RADV and other federal reviews. You are the final check on the integrity of our clinical data repositories.
5. Star Ratings Support: Manage the operational side of quality metrics, ensuring the data systems for closing HEDIS and CAHPS gaps are functioning correctly.
6. Regulatory Compliance: Monitor and implement all CMS regulatory changes to ensure the MA line remains in total compliance with federal law. 
Job Duties<ul><li>
Maintains punctual, regular and predictable attendance.</li><li>
Works collaboratively with the Director of Equity &amp; Tribal Partnerships on quality measures.</li><li>
Respectfully takes direction from leadership.</li><li>
Meets all required training including those listed in Relias Learning Module System (LMS).</li><li>
Performs other duties as assigned.</li></ul> 
On Call Responsibilities
This position does not have any on-call responsibilities.
Supervisory Responsibilities
This position does not have any supervisory responsibilities. 
Job Requirements<ul><li>
MA Leadership: Significant experience leading the operational side of a Medicare Advantage Plan.</li><li>
Coding and Star Mastery: Expert knowledge of the CMS-HCC risk adjustment model and the Stars program.</li><li>
Financial Oversight: Proven ability to manage a budget and oversee complex financial data reconciliations.</li><li>
Data Management: Comfort working with large-scale data extracts and translating them into actionable operational plans.</li></ul>
Core Competencies<ul><li>
Operational Precision: A focus on accuracy, from the June bid submission and revenue reconciliation down to the last cent of a provider incentive payment.</li><li>
System Thinking: The ability to trace how a regulatory or coding shift at the federal level translates into a direct financial impact on our local operations and the communities we serve.</li><li>
Urgency: A track record of meeting strict federal deadlines while maintaining high standards for data integrity.</li></ul>
Qualifications<ul><li>
Bachelor&rsquo;s degree in Health Administration, Business Administration, Public Health, or related field (Master&rsquo;s degree preferred)</li><li>
7&ndash;10+ years of experience in healthcare administration, with significant experience in Medicare Advantage</li><li>
Strong knowledge of CMS regulations, risk adjustment, and value-based care models</li><li>
Experience with healthcare analytics, quality improvement, and financial management</li></ul>
Experience
MA Leadership: Significant experience leading the operational side of a Medicare Advantage Plan.
Certificates, Licenses, and/or Registrations
Valid Oregon Driver&rsquo;s License and vehicle insurance. 
Technical Skills
Familiarity with the Healthcare industry.
Exceptional writing, editing, and proofreading skills.
Excellent organization and time-management skills.
Excellent computer skills, including the Microsoft Office Suite (Outlook, Word, PowerPoint, and Excel).
Knowledge of and compliance with HIPAA regulations.
Knowledge of project management and/or change management. 
Interpersonal Skills
Trust: Promotes honesty, transparency, and diligence. Approaches leadership with mindset of &ldquo;power with&rdquo; rather than &ldquo;power over&rdquo; and regularly includes others in planning and decision-making. Able to make and communicate difficult decisions in the best interest of AllCare Health.
Innovation: Ready to take advantage of unexpected opportunities; adapts quickly to change and is a teacher to assist with change within the organization. Commits to solving unresolved issues in an effort to collaborate and model problem solving. Proactively develop solutions to challenges, including by constantly looking at big-picture progress and thinking about people.
Relationships: Enthusiasm for meeting and engaging with people. Able to put people at ease, especially when there are lines of difference. Identifies and intervenes in problematic dynamics. Listens closely to understand needs or concerns and takes steps based on that input. Gets back to people in a timely manner. Takes pride in providing clear and helpful information.
Voice: Brings a clear vision and recognizes the value of divergent perspectives. Provides equity-centered conflict transformation support, interventions, and training in the team and across departments. Commits to and understands concepts of equity, belonging, and inclusion in the workplace. Effectively works and collaborates across differences. A working knowledge and understanding of the ways implicit bias, personal identity, and power and privilege impact individuals, organizations and systems. 
Physical Demands &amp; Work Environment
The physical demands described here are representative of those that must be met by an employee to successfully perform the essential duties of this job. The work environment characteristics described here are representative of those an employee encounters while performing the essential duties of this job. Reasonable accommodation may be made to enable individuals with disabilities to perform the essential duties.
The employee must occasionally lift and/or move up to 10 pounds. While performing the duties of this job, the employee is regularly required to sit; use hands to finger, handle, or feel and talk or hear. The employee is occasionally required to stand, walk and reach with hands and arms. The noise level in the work environment is usually moderate.
The employee must be able to work onsite for all scheduled shifts.
The employee must be able to travel (locally, occasionally, as needed.)</div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div> 

M-F 8:00AM-5:00PM with a 1 hour lunch and two 15 minute paid breaks
 
40 Hours</div>

DIRECTOR, MEDICARE ADVANTAGE

<div>We Are Seeking Qualified Candidates to Join Our Team!
AllCare Health offers competitive wages, an excellent benefits package including affordable healthcare, 401k retirement, wellness programs, and flexible schedule options.
Summary of the Position
This position supports claims operations and financial integrity by performing a variety of administrative and department functions related to claims processing, system COB updates, and audit support. Responsibilities include managing Coordination of Benefits (COB) reporting, implementing updates within the EZ-CAP claims system, processing refunds and overpayment recoveries, and assisting with internal and external audit activities, including HSAG, OHA, CMS, and financial audits. The role also involves reviewing claims identified through monitoring reports, ensuring issues are researched and resolved appropriately, and supporting check run activities to help ensure accurate and timely provider payments. This position works collaboratively with all claims staff, finance, compliance, and IT teams to maintain efficient operations and ensure adherence to regulatory and organizational requirements.
Essential Duties 
1. Maintain and update Coordination of Benefits (COB) information, including reporting, verification, and system updates to ensure accurate claims processing 
2. Review, research, and process refund requests and overpayment recoveries, ensuring compliance with contractual, regulatory, and internal policies 
3. Provide departmental support for internal and external audits, including preparation of documentation and data requests for entities such as HSAG, CMS, and financial auditors 
 
Qualifications
Ability to perform essential job duties with or without reasonable accommodation and without posing a direct threat to safety or health of employee or others. To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential duties.
Education
High school diploma or general education degree (GED) required. College degree in an applicable field is preferred.
Experience
One to two years related experience and/or training in administrative and/or medical claims processing required. EZ-CAP claim processing system experience is highly preferred.
Certificates, Licenses, and/or Registrations 
This position does not require any certificates, licenses, or registrations. The following certifications are preferred for this job role: 
<ul><li>Certified Professional Coder (CPC)</li><li> 
Certified Clinical Medical Assistant (CCMA)</li><li>Certified Billing and Coding Specialist (CBCS)</li><li>Certified Medical Administrative Assistant (CMAA)</li><li>Certified Coding Specialist (CCS)</li></ul> 

Technical Skills 
<ul><li>Knowledge of and compliance with HIPAA regulations.</li><li>Proficient in data entry and use of claims management systems</li><li>Knowledge of Medicare and Medicaid, procedures, and regulatory requirements</li><li>Basic understanding of medical coding and billing practices</li><li>Strong attention to detail and ability to identify discrepancies or inconsistencies</li><li>Excellent organizational skills and ability to manage multiple tasks efficiently</li><li>Excellent communication skills, both written and verbal, for interaction with internal and external stakeholders</li><li>Exceptional writing, editing, and proofreading skills.</li><li>Excellent computer skills, including the Microsoft Office Suite (Outlook, Word, PowerPoint, and Excel).</li><li>Skilled at breaking a project into definable and measurable tasks and tracking progress to completion.</li><li>Excellent customer service skills to respond appropriately and interact positively with upset customers.</li></ul>
Interpersonal Skills<ul><li>Reliable, confident, and effective in fostering positive relationships.</li><li>Demonstrates accountability, inspires trust, and connects well with colleagues.</li><li>Trustworthy, accountable, and skilled at collaborative engagement.</li></ul>
Language Skills 
Ability to read and interpret documents such as safety rules, operating and maintenance instructions, and procedure manuals. Ability to write routine reports and correspondence. Ability to speak effectively before groups of customers or employees of organization. 
 
Mathematical Skills
Ability to calculate figures and amounts such as discounts, interest, commissions, proportions, percentages, area, circumference, and volume. Ability to apply concepts of basic algebra and geometry.
Computer Skills
Has advanced basic computer job skills including logging on to systems, ability to communicate by email, ability to compose documents, enter database information, create presentations, download forms, and preserve/backup important data.
Reasoning Ability
Ability to apply common sense understanding to carry out detailed but uninvolved written or oral instructions. Ability to work with problems involving a few concrete variables in standardized situations.
Physical Demands &amp; Work Environment
The physical demands described here are representative of those that must be met by an employee to successfully perform the essential duties of this job. The work environment characteristics described here are representative of those an employee encounters while performing the essential duties of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential duties.
The employee must occasionally lift and/or move up to 10 pounds. While performing the duties of this job, the employee is regularly required to sit; use hands to finger, handle, or feel and talk or hear. The employee is occasionally required to stand; walk and reach with hands and arms. The noise level in the work environment is usually moderate. 
 
<ul><li>The employee must be able to work onsite, as needed.</li><li>The employee can work from a home office, occasionally.</li></ul> 
Company Overview
AllCare Health Website: https://www.allcarehealth.com.
AllCare Health is incorporated as an Oregon Benefit Corporation and has earned the coveted Certified B Corp&reg; status since 2017. As such, AllCare Health considers its impact on community, society, and the environment in all business decisions. We have long recognized the value in social, economic, and environmental concerns of our employees, customers, and community members. (Learn more about B Corps at https://bcorporation.net/about-b-corps)
AllCare Health headquarters are located in Grants Pass in Southern Oregon on the Rogue River, surrounded by mountains, forests, small farms, and breathtaking views. This thriving and energetic community is ideal for families and outdoor enthusiasts, with a temperate Pacific Northwest climate. We enjoy easy access to outdoor sports and recreation, river rafting, fishing, hiking, biking, wineries, outdoor concerts, the world-famous Ashland Shakespeare Festival, the stunning Oregon coast, magnificent redwood forests, pristine beaches, and much more.
The AllCare Health family of businesses is guided by our corporate principles:
Purpose | Working together with our communities to improve the health and well-being of everyone.
Values | Trust, Innovation, Relationships, and Voice.
Vision | Thriving, Inclusive, and Equitable communities.
Brand Promise | Changing Healthcare to Work for You.
AllCare Health is dedicated to building a diverse and authentic workplace centered in belonging and serving our growing community. If you are excited about this open position but your experience does not align perfectly with every qualification in this post, we encourage you to apply anyway or reach out to our human resources department. You may just be the right candidate for this role or others.
If you need accommodations, help in the application process, or wish to receive this job announcement in an alternative format, please call 541-471-4106 and ask for Human Resources.
All qualified applicants will receive consideration for employment without regard to race, religion, color, national origin, sexual orientation, gender identity, sex, age, protected veteran or disabled status, or genetic information. 
699 - Claims Processing Assistant_March2026.pdf</div>

CLAIMS PROCESSING ASSISTANT

Join AllCare Management Services and explore 2   exciting career opportunities. They're hiring for various roles with options for remote or on-site work. Apply today and become part of their innovative team.

AllCare Management Services

About Company

DIRECTOR, MEDICARE ADVANTAGE

CLAIMS PROCESSING ASSISTANT