Job Details

Join BoldAge PACE and Make a Difference!

Why work with us?

• A People First Environment: We make what is important to those we serve important to us.
• Make an Impact: Enhance the quality of life for seniors.
• Professional Growth: Access to training and career development.

Competitive Compensation:

• Medical/Dental
• Generous Paid Time Off
• 401K with Match*
• Life Insurance
• Tuition Reimbursement
• Flexible Spending Account
• Employee Assistance Program

BE PART OF OUR MISSION!

Are you passionate about helping older adults live meaningful, independent lives at home with grace and dignity? BoldAge PACE is an all-inclusive program of care, personalized to meet the individual health and well-being needs of our participants. Our approach is simple: We listen to our participants and their caregivers to truly understand their needs and desires.

Claims Processing Manager

JOB SUMMARY: The Claims Processing Manager, reporting to the Director of Claims Processing, oversees the end-to-end claims process to ensure timely, accurate, and compliant reimbursement. This role drives operational efficiency, monitors key performance metrics, and implements strategies to reduce denials and optimize revenue. The Manager collaborates with Finance, Compliance, Clinical Operations, and external partners to strengthen revenue cycle performance, ensure regulatory compliance, and support organizational financial objectives.

ESSENTIAL DUTIES AND RESPONSIBILITIES:

• Oversee daily operations of the claims processing function, ensuring timely submission, adjudication, and resolution of claims.
• Monitor and analyze key performance metrics such as denial rates, reimbursement trends, aging reports, and processing timelines.
• Collaborate with the CFO and Finance team to support revenue forecasting, cash flow optimization, and financial reporting accuracy.
• Develop and implement strategies to reduce denials, improve clean claim rates, and enhance overall reimbursement outcomes.
• Ensure compliance with applicable federal, state, payer, and regulatory requirements (e.g., CMS guidelines, billing regulations).
• Lead continuous improvement initiatives to enhance workflow efficiency, automation, and internal controls.
• Manage relationships with third-party billing vendors, clearinghouses, and payer representatives.
• Partner with Compliance and Clinical leadership to ensure accurate coding, documentation standards, and audit readiness.
• Train, mentor, and develop claims processing staff to ensure high performance and accountability.
• HIPAA, CMS guidelines, audit preparation
• Support system enhancements, reporting improvements, and integration of technology solutions to optimize claims management processes.

EXPERIENCE AND EDUCATION:

• Bachelor's degree in Healthcare Administration, Business, Finance, or related field required
• 2+ years of leadership or supervisory experience managing claims, billing, or reimbursement teams
• Strong knowledge of payer requirements, CMS guidelines, coding practices (ICD-10, CPT, HCPCS), and reimbursement methodologies
• Demonstrated experience improving clean claim rates, denial management outcomes, and A/R performance
• Knowledge of regulatory and compliance requirements impacting claims processing (e.g., CMS, HIPAA)
• 5-7+ years of progressive experience in claims processing, revenue cycle management, or healthcare billing operations
• Denial management, appeals, root cause analysis, contract reimbursement, underpayment resolution
• Experience working cross-functionally with Finance, Compliance, Clinical Operations, and external vendors
• 1 year of experience working with a frail or elderly population preferred. If this is not present, training will be provided upon hiring (If applicable for the role).

PRE-EMPLOYMENT REQUIREMENTS:

• Must have reliable transportation, a valid driver's license, and the minimum state required liability auto insurance.
• Be medically cleared for communicable diseases and have all immunizations up to date before engaging in direct participant contact.
• Employment with BoldAge PACE is contingent upon successful completion of post-offer pre-employment screening and verification processes

BoldAge PACE 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, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws.

* Match begins after one year of employment

Full-time
Monday - Friday
Days
Full-time