Prospect Medical Systems - CA Job - 37288202 | CareerArc
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Company: Prospect Medical Systems - CA
Location: Los Angeles, CA
Career Level: Mid-Senior Level
Industries: Hospitals, Health Care

Description

Current Employees Click HERE

Current employees can apply directly through the Internal Careers Center online for Prospect Medical job openings in California. For a streamlined application process, all you need is your four-digit employee ID number and a digital copy of your résumé handy before you apply.

 

Senior Eligibility Processor

We are hospitals and affiliated medical groups, working closely together for the benefit of every person who comes to us for care. We build comprehensive networks of quality healthcare services that are designed to offer our patients highly coordinated, personalized care and help them live healthier lives. Through collaboration, we strive to provide all of our patients and medical group members with the quality, affordable healthcare they need and deserve.

The Senior Eligibility Processor is responsible for the activities related to the process of uploading Health plan eligibility files to Prospect's core system (IDX), for the purpose of managing eligibility information. This role requires someone to function with a high degree of independence, dependability, and data entry accuracy. The position is responsible for the daily operational activities which will ensure successful and accurate inbound and outbound transmissions.

Job Requisition 

The Senior Eligibility Processor is responsible for the activities related to the process of uploading Health plan eligibility files to Prospect's core system (IDX), for the purpose of managing eligibility information. This role requires someone to function with a high degree of independence, dependability, and data entry accuracy. The position is responsible for the daily operational activities which will ensure successful and accurate inbound and outbound transmissions.

Meet with health plan and vendor(s) on issues with health plan file data. Articulate eligibility issues and processes with health plan/vendor contacts and management. Perform testing and troubleshooting on new or updated health plan files.  Establish processes for new health plan files.

Administer all aspects of health plan eligibility file loads into eligibility management software and IDX, including eligibility file setup, data integrity analysis, field mapping, and implementation of network affiliation and plan codes.  Maintain accuracy in working within eligibility management software and IDX.  Perform Monthly Reconciliations to ensure variances from the health plan files to IDX are <=1% variance or <= 50-member difference.  Work directly with health plans and vendor contacts on issues involving health plan files and data integrity.

Generate audit reports and guide Eligibility Team on working audit reports work queues for assigned health plan.  Research identified issues and escalate errors to the appropriate departments. Ensure that operational duties will meet or exceed all relevant stated Service Level Agreements (SLA). Train new hires as a subject-matter expert on Eligibility processes.

Actively participate in supporting special projects as requested. Complete variety of projects of an analytical nature as assigned by management or identified through own work.

 

Qualifications

Minimum Education: High School Diploma/BA, or equivalent work experience. 

Minimum Experience: Experience operating PC-based software programs.  4+ years working within Enrollment/Eligibility for a health plan, IPA, Medical Group, or Provider Office.  Experience using SQL and Access databases and other software applications within Enrollment/Eligibility.  Experience working within IDX a plus.  Experience pulling files via health plan websites, SFTP, and e-mail.      

Req. Certification/Licensure: NONE

Employee Value Proposition

Prospect Medical Holdings, Inc., is guided by a diverse and highly experienced leadership core. This group maintains the vision that has made Prospect a needed difference-maker in the lives of so many patients today, and many executives contribute to our continued efforts. As a member of our highly effective team of professionals you will receive:

  • Company 401K
  • Medical, dental, vision insurance
  • Paid time-off
  • Life insurance

Prospect Medical Systems has a zero-tolerance policy regarding the use of drugs and alcohol.  Our Company is committed to maintaining a productive, drug free workplace that keeps employees and patients safe from harm.  For this reason, we require applicants to pass a screening for drug use as a condition of employment.  This includes: alcohol, marijuana, cocaine, opiates and methamphetamines.

How to Apply

To apply for this role, or search our other openings, please visit http://pmh.com/careers/ and click on a location to begin your journey to a new career with us!

We are an Equal Opportunity/ Affirmative Action Employer and do not discriminate against applicants due to veteran status, disability, race, gender, gender identity, sexual orientation or other protected characteristics. If you need special accommodation for the application process, please contact Human Resources.

EEOC is the Law: https://www1.eeoc.gov/employers/poster.cfm

Keywords: Acute Care, Eligibility Lead, reconciliations, ad hoc reports, transmissions, Eligibility, QC, Service Levels Agreements, SLA, Perform trend analysis, incident tracking, P&P's, SQL, Access databases, IDX, SFTP, Managed Health Care

 


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