Eligibility Processor I at Prospect Medical Holdings, Inc. in Orange, California

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