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Eligibility Processor I

Remote: 
Full Remote
Contract: 
Full time
Experience: 
Mid-level (2-5 years)
Work from: 
Canada

Offer summary

Qualifications:

Two years of healthcare work experience, High School Diploma or GED.

Key responsabilities:

  • Upload and update eligibility files
  • Verify claims and interact with health plans
  • Create spreadsheets in Excel
  • Conduct research analysis on eligibility
  • Understand various healthcare product lines
Prospect Medical Systems logo
Prospect Medical Systems SME https://prospectmedicalsystems.com/
501 - 1000 Employees
About Prospect Medical Systems
With approximately 9,000 physicians to serve our 260,000 members, Prospect Medical Systems is proud to be among the most innovative medical systems in California, Texas and Rhode Island. In the months and years ahead, we will be offering our services in other states and other markets throughout the nation. Our extensive care services range from primary care and specialty physician services to acute care hospital and skilled nursing facilities to behavioral health and wellness services. Each of our Independent Physician Associations (IPAs) and networks support the use of advanced diagnostic and treatment tools to provide our members with convenient access to state-of-the-art healthcare. Our pledge to members is that we will give you exceptional care delivered by compassionate physicians who have a strong commitment to each and every patient. Our physicians work closely with teams of skilled nurses and other healthcare professionals. Prospect Medical contracts with most major health plans, and we serve all product lines, including Commercial, Medicare, Medicaid, Medicare/Medicaid (Medi-Medi) and Health Insurance Exchange. To further improve the health of the communities we serve, Prospect Medical offers comprehensive health education classes and support services through our numerous outreach programs. Diversity and Inclusion Within Our Workforce At Prospect Medical, we believe that a diverse and inclusive environment enriches our workforce and the communities we serve. To that end, we embrace the diversity of our coworkers, physicians, vendors and patients. We do not tolerate harassment or discrimination on the basis of race, ethnicity, religion, gender, sexual orientation, gender identity or expression, national origin, age, disability, veteran status or any other characteristics protected by law. We embrace diversity because it is our culture, and it is the right thing to do.
See more Prospect Medical Systems offers

Job description

Job Description

The Eligibility Processor is responsible for uploading of eligibility files monthly, as well as updating IDX system with add, changes, and terminations, required to do research analysis on eligibility files. This person will be familiar with verifying eligibility through the health plan web sites, as well as on the telephone. Verify manual claims, electronic claims, and authorizations. Detail oriented claims/authorizations very helpful. Understand and interpret different product lines within the healthcare industry.

Responsibilities

Download and merge eligibility files from health plan web sites.|Upload Eligibility files to subsystem. Update system with add, changes, and terminations.|Knowledge of health plan websites. Be able to communicate effectively with the health plans.|Knowledgeable with HMO/Medicare/Medical products. Interact with diverse departments.|Create spreadsheets in Excel. Verify Capitation discrepancies.

Qualifications

Two (2) years healthcare work experience High School Diploma or GED

“Location-Based Pay Adjustment”

About Us

With approximately 9,000 physicians to serve our 260,000 members, Prospect Medical Systems is proud to be among the most innovative medical systems in California, Texas and Rhode Island. Our extensive care services range from primary care and specialty physician services to acute care hospital and skilled nursing facilities to behavioral health and wellness services. Each of our Independent Physician Associations (IPAs) and networks support the use of advanced diagnostic and treatment tools to provide our members with convenient access to state-of-the-art healthcare. For 25+ years, Prospect Medical has been focused on our mission of supporting independent physicians where, through risk arrangements, we work closely together with health plans, facilities and healthcare physicians for the benefit of every person who comes to us for care. We provide quality healthcare services that are designed to offer our patients highly coordinated, personalized care and that help them live healthier lives. Prospect Medical Systems manages highly successful IPAs by leveraging our best-practices, results-driven administrative services to manage patients under risk arrangements with health plans/CMS.

Required profile

Experience

Level of experience: Mid-level (2-5 years)
Spoken language(s):
English
Check out the description to know which languages are mandatory.

Hard Skills

Pharmaceutical Product ManagementData AnalysisMedical Practice ExperienceMedicareData Entry

Other Skills

  • Detail Oriented
  • Verbal Communication Skills
  • Microsoft Excel
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