Habitat Health

Director

• Sets the vision, operating standards, and governance framework for Part C authorizations, claims processing (including TPA oversight), and encounter data operations, ensuring regulatory compliance and operational consistency.
• Oversees day-to-day adjudication operations, ensuring a controlled, disciplined, regulatorily compliant and exceptionally reliable operational environment that is timely, accurate, and has a high-quality output by internal team members and external vendors, as necessary.
• Responsible for establishing and maintaining and evolving reports and performance management frameworks, including KPIs, audit outcomes, utilization metrics, and risk indicators, and communicate insights to senior leadership.
• Owns end-to-end encounter data processing including reviewing and monitoring encounter data submissions for accuracy, ensuring discrepancies are identified, corrected, and communicated through collaboration with crossfunctional teams; maintaining documentation and troubleshooting processes to support data quality.
• Engages with Enrollment & Eligibility to resolve data discrepancies impacting member benefits or provider assignments. Partners with Provider Network on contract load timing, unclear terms, and pricing interpretation issues.
• Conducts retrospective reviews and maintains reporting that evaluates the accuracy, timeliness, and effectiveness of service authorization processes, providing clear summaries of findings and outcomes to leadership to drive continuous improvement.
• Monitors daily, weekly, and monthly inventory at the claim, and authorization and encounter data level to anticipate risk and maintain a stable production environment.

Director, Part C & Authorizations

• Own end-to-end census integrity and member coverage continuity for all PACE participants.
• Set the vision and operating standards for census, enrollment, eligibility, and member services.
• Provide oversight and accountability for day-to-day enrollment, eligibility, and Medicaid re-eligibility operations.
• Establish and govern departmental policies, workflows, and operational controls.
• Own operational performance management, including KPIs, audits, and risk identification.
• Lead and develop a high performing team responsible for enrollment and eligibility.
• Serve as a cross functional partner to resolve complex enrollment and eligibility issues.
• Oversee membership maintenance, data integrity, and member communications.

Director, Census & Member Services

Data Engineer

• Support the development and maintenance of secure, scalable data systems that enable clinical, operational, and financial analytics in a HIPAA‑regulated environment.
• Contribute to building and operating data pipelines that ingest, transform, and standardize data from internal and external healthcare sources such as EHRs, claims vendors, and SDOH APIs.
• Work closely with analysts and business stakeholders to understand requirements and help create reliable, analytics‑ready datasets and basic data models.
• Assist in documenting data processes and governance practices, including data lineage, access controls, and handling procedures for sensitive health information.
• Participate in data quality efforts by implementing validation checks, monitoring data flows, and helping identify anomalies that could impact downstream analytics.
• Help develop and maintain reusable dbt models and shared data transformations, with exposure to open healthcare data models like Tuva, OMOP, or FHIR.
• Collaborate with senior engineers to improve infrastructure and team processes, taking on increasing responsibility as skills grow and the data engineering function expands.

Healthcare Data Engineer

Project Manager

• Oversee projects to maintain schedule and ensure projects are completed in the allotted time frame
• Hands on installation of clinical and administrative equipment and supplies necessary for a functioning PACE center
• Responsible for driving project progress internally and externally
• Proactively monitor, track and take necessary action to identify and mitigate risks and deliver projects at or below estimated cost
• Determine project schedule from initiation through handover
• Coordinate with other departments to execute each phase of the project
• Deliver excellent customer service throughout the project
• Meet with contractors and partners when needed
• Identify and escalate any necessary design changes or change orders

Project Manager, New Markets

People Operations

• In partnership with the Sr. Director of People, create and lead scalable and innovative processes for onboarding, offboarding, job changes, and team member lifecycle processes in preparation for rapid growth.
• Assist with policy creation, audit readiness, and compliance governance in a multi-state environment, with a heavy focus on California.
• In partnership with Executive Directors and Clinical Leadership, create and optimize physician onboarding programs.
• Manage outsourced vendors including home care providers, transportation vendors, and ancillary vendors offering LOA support, etc.
• Monitor ever-changing employment laws in a multi-state environment and make recommendations for policy changes.
• Owns the People Operations calendar to ensure we are prepared for key activities within the team (Open Enrollment, etc.).
• Serves as the lead for annual Open Enrollment, working closely with benefit administrators, owning team member communications, ensuring system readiness, and maintaining benefits compliance across multi-state operations.
• Assist with total rewards efforts including maintaining career architectures, pay ranges, and system implementations.
• Partner with the People Operations Generalist to address complex team member questions and requests and maintain service-level expectations for People Operations.
• Serve as a thought partner to team members and managers to navigate complex questions and interpretation of policies.

Manager, People Operations

Medical Billing and Coding

• Review participant medical records and provider documentation to identify, validate, and code risk-adjustable diagnoses in accordance with CMS-HCC v24 and v28 guidelines.
• Ensure complete, accurate, and compliant ICD-10-CM coding with a primary focus on concurrent and retrospective reviews (with flexibility for pre-visit planning as needed).
• Draft and submit compliant provider queries to clarify documentation and support accurate coding.
• Track and follow through on open queries—engaging with providers, monitoring responses, and closing them out appropriately.
• Apply strong critical thinking skills to resolve complex documentation and coding scenarios.
• Maintain clear, professional communication with providers and internal teams to support documentation completeness.
• Stay current with CMS, OIG, and industry regulations related to risk adjustment and coding compliance.

Certified Risk Adjustment Coder

Operations

• Advance Strategic Initiatives – Lead enterprise-wide initiatives, including clinical strategy, platform and tool rollouts, and operating model enhancements, that strengthen Habitat’s offering and organizational capabilities.
• Standardize and Scale Market Operations – Contribute to the development of Habitat’s launch frameworks, processes, and tools that improve operational execution that can be replicated across new markets and partners, setting Habitat up for future scale and expansion.
• Support Operational Execution – Track progress, surface risks, and drive accountability across the Operations organization to ensure partnership and enterprise initiatives stay on course.
• Translate Strategy into Action – Distill complex problems into structured solutions, enabling timely decision-making by leadership. Bring a “roll up your sleeves” mindset, creating clarity and forward momentum in dynamic, evolving situations.

Manager, Strategy and Operations

Manager

• Oversees day-to-day adjudication operations, ensuring a controlled, disciplined, regulatorily compliant and exceptionally reliable operational environment.
• Responsible for establishing and maintaining reports to support the efficacy of each service authorizations process.
• Review and monitor encounter data submissions for accuracy, maintaining documentation and troubleshooting processes.
• Engages with Enrollment & Eligibility to resolve data discrepancies impacting member benefits or provider assignments.
• Conduct retrospective reviews and maintains reporting evaluating the accuracy, timeliness, and effectiveness of service authorization processes.
• Monitors daily, weekly, and monthly inventory to anticipate risk and maintain a stable production environment.

Manager, Part C – Authorizations

Supply Chain

• Manage procurement, inventory control, distribution, and logistics for medical supplies and equipment.
• Negotiate contracts with vendors, group purchasing organizations (GPOs), and suppliers.
• Monitor supplier performance, pricing, and service-level agreements.
• Analyze spend data, utilization trends, and cost-saving opportunities.
• Ensure compliance with healthcare regulations, accreditation standards, and internal policies.
• Maintain accurate documentation, traceability, and recall management processes.
• Implementation and optimization use of ERP, inventory management, and procurement systems.
• Collaborate with clinical leaders, nursing, physicians, and operations to align supply decisions with patient care needs

Supply Chain and Procurement Manager

• Lead day-to-day census, enrollment, eligibility, and Medicaid re-eligibility operations, ensuring all transactions are timely, accurate, and fully compliant.
• Develop, maintain, and enforce department policies, procedures, workflows, and monitoring routines, ensuring adherence by internal teams and external vendors.
• Produce and report operational metrics, audit findings, enrollment accuracy, and KPIs, identifying risks and driving timely remediation.
• Supervise, mentor, and develop staff while setting clear expectations and maintaining accountability for performance and quality.
• Serve as liaison with internal and external stakeholders to resolve escalated eligibility and enrollment discrepancies and ensure seamless coverage.
• Oversee membership maintenance across systems, including reconciliations, CMS interactions, and Medicare/Medicaid coordination of benefits.
• Own creation and maintenance of member correspondence and fulfillment materials in alignment with CMS guidance and plan policy.
• Identify and drive continuous improvement initiatives to enhance efficiency, accuracy, and participant experience.

Manager, Census & Member Services

Recruitment

• In partnership with PACE Executive Directors and Center Leadership, contribute to the recruitment process for clinical and operational roles in our PACE markets, including sourcing, scheduling, and closing candidates.
• Become intimately familiar with Habitat’s core values and cultural competencies to ensure we are staffing our clinic with a team that cares and creates joy for our participants.
• Establish and maintain a network of qualified candidates.
• Manage candidate communications and interview processes using our applicant tracking system.
• Project manage the interview process from start to finish and align the hiring team to ensure Habitat meets critical hiring deadlines.
• Craft interview questions that accurately reflect the requirements of each position.
• Complete all necessary documentation accurately and promptly.
• Source potential candidates through professional associations and online platforms (e.g., LinkedIn).
• Assist and participate in the planning, advertising, and execution of hiring fairs.
• Other responsibilities as needed.

Talent Acquisition Specialist

• Create and lead scalable and innovative processes for onboarding, offboarding, job changes, and team member lifecycle processes in preparation for rapid growth.
• Assist with policy creation, audit readiness, and compliance governance in a multi-state environment, with a heavy focus on California.
• In partnership with Executive Directors and Clinical Leadership, create and optimize physician onboarding programs.
• Manage outsourced vendors including home care providers, transportation vendors, and ancillary vendors offering LOA support, etc.
• Monitor ever-changing employment laws in a multi-state environment and make recommendations for policy changes.
• Owns the People Operations calendar to ensure we are prepared for key activities within the team (Open Enrollment, etc.).
• Serves as the lead for annual Open Enrollment, working closely with benefit administrators, owning team member communications, ensuring system readiness, and maintaining benefits compliance across multi-state operations.
• Assist with total rewards efforts including maintaining career architectures, pay ranges, and system implementations.
• Partner with the People Operations Generalist to address complex team member questions and requests and maintain service-level expectations for People Operations.
• Serve as a thought partner to team members and managers to navigate complex questions and interpretation of policies.

People Operations Manager

Customer Success Manager

• Serve as a liaison between business stakeholders and technical implementation: assist with defining and scoping requests.
• Perform enhancements, automation, and development within Salesforce: adjust system logic, build complex flows, expand modules, and refine existing functionality for better scalability.
• Build and maintain dashboards, reports, and other visualizations to support business insights, as well as validation rules to ensure data quality.
• Produce both technical documentation (code, system behavior, integration points) and process documentation (how the business uses Salesforce, workflows, etc.).
• Review the current state of Salesforce setup to identify gaps, inefficiencies, or risks; provide recommendations to set up better long-term scalability and success.
• Handle day-to-day requests: bug fixes, small enhancements, and questions from users.
• Admin responsibility: reviewing/administering structure, permissions, etc.