ELIGIBILITY COORDINATOR

Company: Network Medical Management Inc
Location: Alhambra
Posted on: January 12, 2021

Job Description:

SUMMARYOrganizes, maintains, and update Ez-Cap eligibility information. Makes sure members' eligibility is up-to-date in Ez-Cap from contracted Health Plans, checks health plan web sites and contacts Medi-Cal and Medicare offices. Handles checking eligibility, benefits, co-pays for authorization and claims department. Tracks work by keeping accurate logs of all the different projects of maintaining member eligibility. Working on conflicts and rejects related to members' eligibility. Assists internal representatives with any eligibility questions. Support other various projects as assigned by lead or director.ESSENTIAL DUTIES AND RESPONSIBILITIES, include the following:* Assume day-to-day administrative responsibilities related to Eligibility.* Contact various health plans to verify member eligibility with the plans and IPA's.* Download and maintain data from Health Plan either through web site, discs, ftp sites and any other ways data is Transmitted.* Check membership from various sources using Datatug, checking web sites manually, or calling health plans directly.* Monthly rejects and conflicts for members that needed to be added and termed in the system for monthly capitation run.* Assists the claims department to verify eligibility and other health coverage from the health plans.* Assists with EDI and Member Can't find of claims sent in from providers.* Assists with daily phone queue from providers, members and vendors related to eligibility and capitation.* Research member additional insurance such as dual, Medicare, Medi-Cal, and CCS. Document in Ez-Cap.* New providers' membership not on E-list will be manually inputted.* Other duties may be assigned.QUALIFICATIONSTo 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 functions.* Intermediate knowledge of MS Word, Excel, Access and basic medical terminology is required.* Ability to understand and work with proprietary software applications.* Organizational ability and ability to exercise good judgment.* Typing speed 40+WPM and knowledge of 10 key desired.EDUCATION and/or EXPERIENCEOne to two years related experience and/or training; or equivalent combination of education and experience. Bachelor's degree (B.A.) from four-year College or university will be suitable as well.

Keywords: Network Medical Management Inc, Alhambra , ELIGIBILITY COORDINATOR, Other , Alhambra, California