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Enrollment/Eligibility Coordinator - Managed Care

Location : Mission Hills CA
Job Type : Temp/Contract
Reference Code : 16065
Start Date : 12/29/2020
Hours : Full Time

Job Description :
Temp/Contract: 90 days (possible temp to hire) 

Hours/Schedule: Mon-Fri - 7:00am–4:00pm or 7:30am-4:00pm 

Location: Remote - will be provided with PC, supplies, and training will be virtual with a live instructor. 

 

JOB DESCRIPTION: 

 

This will be for enrollment/eligibility and benefits verification and updating (in Epic). 

 

The Enrollment Coordinator position requires understanding of managed care systems and the importance of member eligibility/benefits as the foundation of the process. Effective communication skills and a working knowledge of managed care and health plan contracts are critical as are good judgment and decision-making skills. Strong interpersonal relations and team building skills are a requirement for internal and external purposes. Experience in managed care and processing enrollment is important. 

 

- Responsible for processing member eligibility and benefits. 

- Assists physicians, physician offices, vendors and health plans in verifying eligibility/benefits, answering enrollment questions and investigating enrollment problems. 

- Follows up on outstanding issues to ensure completion.

- Verifies eligibility with health plans either by the internet or telephone. 

- Determines Coordination of Benefits based on established industry guidelines. 

- Works with the Claims, Referrals and Customer Relations Departments on any urgent enrollment issues so as not to interrupt patient care. 

- Assists the Utilization Management department on verifying eligibility for patients admitted to the hospital and other facilities 

 

QUALIFICATIONS: 

 

- Ideal candidate will have managed care experience with regard to eligibility and benefits verification. Epic experience is a plus.

- A minimum of 3 years experience in processing enrollment is - preferred.

- Work history emphasis within an independent physician association, management services organization or physician hospital organization is preferred. 

- Must understand data processing policies and procedures related to entering, updating, and maintaining patient enrollment information, including knowledge of Health Plans (HMO, PPO, POS, Medi-Cal, Medicare).
Required Qualifications :
 
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