Eligibility Processor I
: Job Details :

Job DescriptionThe 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.ResponsibilitiesDownload 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.QualificationsTwo (2) years healthcare work experience High School Diploma or GED Location-Based Pay Adjustment About UsWith 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.