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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.
- 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.
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