Eligibility Coordinator - Orange, CA
Orange , CA 92856
Posted 2 months ago
As one of the fastest growing Independent Physician Associations in Southern California, Regal Medical Group, Lakeside Community Healthcare & Affiliated Doctors of Orange County, offers a fast-paced, exciting, welcoming and supportive work environment. Opportunities abound, and enterprising, capable, focused people prosper with us.
We promote teamwork, nurture learning, and encourage advancement for all of our employees. We want to see you excel, because we believe that your success is our success.
Ensure that all EZCap system eligibility data is current and accurate. Researches and maintains systems and changes to existing eligibility in a timely manner. Qualifications:
1. Performs research and analysis of membership
2.Enters new member eligibility records into EZ Cap in accordance with established guidelines.
3.Uses activity analysis reports from the health plans to make changes to existing enrollees; i.e. benefit option changes, terminations, and address changes.
4.Manually audits existing eligibility in EZ Cap against current eligibility.
5.Investigates retroactive cancellations for services rendered by the member after the policy termination date for eligibility guarantee.
6.Researches problem eligibility on authorizations and/or claims forms by calling the health plans or utilizing any other source to resolve the problem.
7.Assists personnel from other departments with eligibility issues.
8.Any other duties as assigned by Lead or Department Head.
9.Monitors queue, web site and email for inquiries. Responds timely to membership inquiries
Courses in bookkeeping, accounting, insurance billing and data processing desirable.
Good verbal and written communication skills.
Computer literate with keyboard skills for data entry.
Employer will consider for employment qualified applicants with criminal histories in a manner consistent with the requirements of the LA City Fair Chance Initiative for Hiring Ordinance.