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Providence Health & Services Eligibility Coordinator I in Mission Hills, California

Description:

Providence is calling a Eligibility Coordinator I (Full Time/Day Shift) to the Providence Facey Medical Foundation in Mission Hills, CA.

We are seeking a Eligibility Coordinator I, who will perform accurate and timely processing of the HMO Pends Report. Update the ESI system. Update of all enrollment files. Work closely with other departments to coordinate correct FSC and plan assignment and coordination of benefits. Complete research for coordination of benefits rules. Completes research for complex cases, as required.

In this position you will have the following responsibilities:

  • Deliver upon the service expectations of both our patients and fellow staff members by listening to their needs; engaging in positive interactions; and following through on promises made in a thoughtful, efficient, timely and courteous manner so that their total outcome is better than expected

  • Respect the dignity, confidentiality and privacy of patients

  • Work in a safe manner, adhering to general safety precautions and standards. Reports any unsafe conditions to their supervisor and/or the safety hotline

  • Update insurance information accurately in the system from GE User Defined Reports, as well as ad hoc reports, for proper claim, encounter, referrals and invoice adjudication

  • Update other pertinent information such as demographics and guarantor information in the system

  • Timely maintenance of benefits updates, in coordination with the Information Systems Department

  • Timely maintenance of the claim scrubbing reports, including complete research and supporting documentation, in order to remain in compliance within contracted adjudication standards

  • Update system information accurately from activity lists which encompasses additions, terminations, transfers and changes on HMO enrollee’s status

  • Timely response to all eligibility inquiries received from various Facey PCP locations, in order to minimize operational disruptions

  • Maintain various reports produced by the Business Office with full supporting documentation.

  • Timely auditing of operations completed by outside vendors

  • Complete ad hoc reporting accurately, as delegated

  • Update system from HMO edit reports, created by outside vendors, as well as those created in-house

Qualifications:

Required qualifications for this position include:

  • Microsoft Word, Excel and Outlook experience

  • Working knowledge of insurances -- PPO, EPO, HMO, Medicare

  • Ablility to work independently and possess strong time management skills

  • Ability to complete comprehensive and accurate research

  • Possess strong decision-making skills

  • Demonstrate excellent customer service ability and communication skills

  • Strong math skills, 10-key by touch, computer skills (Mainframe and Windows) and familiarity with ICD-9 and CPT coding

Preferred qualifications for this position include:

  • Microsoft Access experience

  • Medical group practice or hospital billing and/or collections experience

  • GE/IDX Centricity Business experience

About the organization you will serve:

Facey Medical Group is a multi-specialty medical group with over 160 physicians providing care to the growing population in the North & East regions of Los Angeles & Ventura Counties. Twelve medical clinics, including two urgent care centers and dedicated women's centers, are located across the San Fernando, Santa Clarita, and Simi Valleys. The group began as a single medical practice over 90 years ago.

Facey is part of Providence Health & Services, an integrated, not-for-profit 5-state network of hospitals, care centers, medical clinics, affiliated services and educational facilities spanning from California to Alaska.

We offer a full comprehensive range of benefits - see our website for details

http://www.providenceiscalling.jobs/rewards-benefits/

Our Mission

As expressions of God’s healing love, witnessed through the ministry of Jesus, we are steadfast in serving all, especially those who are poor and vulnerable.

About Us

Providence Health & Services is a not-for-profit Catholic network of hospitals, care centers, health plans, physicians, clinics, home health care and services guided by a Mission of caring the Sisters of Providence began over 160 years ago. Providence is proud to be an Equal Opportunity Employer. Providence does not discriminate on the basis of race, color, gender, disability, veteran, military status, religion, age, creed, national origin, sexual identity or expression, sexual orientation, marital status, genetic information, or any other basis prohibited by local, state, or federal law.

Schedule: Full-time

Shift: Day

Job Category: Customer Service

Location: California-Mission Hills

Req ID: 246705

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