OVERVIEW: The Eligibility Specialist- IPA Operations is primarily responsible for ensuring the timely inload, processing and reconciliation of the Monthly. Bi-Monthly, Weekly, Daily Health Plan Eligibility Data files received from AltaMed contracted health plans. This position also includes reconciliation of member data discrepancy reports, working on claims and authorization queues and assisting with the Eligibility phone queues as required.
RESPONSIBILITIES:
- Understand, adhere to and implement company and department policies and procedures.
- Demonstrate attention to detail and accuracy in work product.
- Inload, process and reconcile monthly, bi-monthly, weekly, daily Eligibility Health Plan Data via Eligibility Manager Program.
- Inload, process and correct eligibility data errors via EZ-NET and EZCap Member Modules as required during Eligibility Inload and Reconciliation Process.
- Perform Eligibility Manager Health Plan Module testing as new Health Plan Contracts are added.
- Interpret Eligibility Health Plan File Data and Specifications.
- Maintain and download Health Plan Eligibility Data as required.
- Assist in Eligibility Department Claims, Authorization and Customer Service Queue maintenance and workflows.
- Assist in Eligibility Phone Queue maintenance.
- Special Projects as assigned by Managed Care Capitation and Eligibility Manager.
- Other Duties as assigned by Managed Care Capitation and Eligibility Manager.
MINIMUM QUALIFICATIONS:
- High School Diploma or equivalent required.
- Minimum of 4 years’ experience of Health Plan Eligibility Data Inload Processing and Reconciliation.
- Minimum 3 years’ experience of Health Plan Eligibility Data Verification.
- EZCAP, EZNET, Eligibility Manager and Datatug Program experience preferred but not required.
SKILLS AND ABILITIES:
- Ability to read, write and speak in a clear and professional manner.
- Excellent customer service skills and the ability to resolve customer issues and or escalate to supervisor as needed.
- Proficient in beginning/ intermediate computer skills and Microsoft Office.
- High degree of organization, strong attention to detail and ability to follow up.
- Accurate data entry, 10 Key and typing at least 45WPM.
- Strong interpersonal skills, able to work independently and in a team environment.
- Ability to multi-task, organize, manage time and prioritize work flow processes.
- Ability to interpret eligibility data as presented on health plan websites and health plan eligibility data files.
- Ability to identify and provide solutions for eligibility data processing inefficiencies.
- Ability to train new staff as needed.
- Knowledge of health care industry, preferably managed care.
Job Type: Full-time
Pay: $25.00 - $27.00 per hour
Benefits:
- 403(b)
- 403(b) matching
- Dental insurance
- Disability insurance
- Employee assistance program
- Employee discount
- Flexible schedule
- Flexible spending account
- Health insurance
- Life insurance
- Paid time off
- Retirement plan
- Tuition reimbursement
- Vision insurance
Schedule:
- Monday to Friday
Work setting:
- Hybrid remote
Ability to commute/relocate:
- Montebello, CA 90640: Reliably commute or planning to relocate before starting work (Required)
Experience:
- Eligibility Data Inload Processing and Reconciliation: 2 years (Required)
Work Location: Hybrid remote in Montebello, CA 90640
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