Providence Request Specialist in Mission Hills, California
Providence is calling a Request Specialist (Full-Time/Day Shift) to Providence Medical Institute in Mission Hills, CA.
We are seeking a Request specialist who will demonstrate competency and knowledge in HMO/EPO/PPO eligibility and benefit coverages. Serves as a liaison between patients, hospitals, health plans, and Providence Medical Institute and Providence Medical Group. Responsible for verification of eligibility and benefits for managed care members.
The incumbent performs all duties in a manner that promotes Providence mission, values, and philosophy. In all aspects, he/she serves as a role model for the values and mission of the organization.
In this position you will:
Perform job functions timely and efficiently:
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.
Work in a safe manner, adhering to general safety precautions and standards. Reports any unsafe conditions to their supervisor and/or the safety hotline.
Verify eligibility, benefits, and researches medical criteria for HMO assigned patients and updates the member’s records as necessary.
Report discrepancies of copay/benefit between health plan’s source documents and internal Providence system.
Ensure requests are submitted timely and accurately prior to entry into the system.
Communicate with providers when requests lack information.
Report referral counts daily to Request Specialist Lead.
Research, reconcile, and update service authorizations on claims research requests. Enters extensions of dates, new authorizations, and/or confirms denials (per Case Manager’s review).
Input retrospective authorizations into various systems.
Call on-call physicians for emergency authorizations and inputs into the system real time.
Serve as liaison between patients, providers, and the organization regarding benefits and eligibility.
Notify patients and providers of routine authorizations or denials by mail and fax.
Notify patients and providers of urgent or stat authorizations or denials by phone.
Interface with patients directly, and schedules appointments accordingly.
Handle phone calls from patients, hospitals and outside providers regarding inquiries on insurance benefits, authorizations, hospital bills and dates of service.
Input authorizations and tracks patients with HIV or on dialysis.
Assist case managers by gathering necessary information needed for review and assists with outbound calls to patients.
Complete required patient notification letters (e.g. extension, carve out, denial, approval letters).
Forward any investigational or experimental requests to the patient’s health plan for review.
Attend required/assigned meetings by the supervisor and manager.
Required qualifications for this position include:
One (1) year experience in a clinic, hospital or related health care industry in a managed care environment, or equivalent in education or medical certification in medical field (i.e. nursing, medical billing and coding, or medical admin assisting).
Ability to use 10-key calculator by touch or sight, type 45 wpm, computer skills (MS Word, Outlook and Excel) and data entry experience.
Ability to multi-task and prioritize.
Must possess excellent customer service and communication skills, answer Customer Service call line calls and data entry, be organized and self-starter.
Preferred qualifications for this position include:
- Knowledge of HMO/EPO/PPO insurance processing, ICD-9 and 10/CPT coding and medical terminology
About the ministry you will serve.
Providence Health & Services Southern California is further developing its physician integration strategy. Historically, the largest asset has been Providence Medical Institute, a medical foundation that provides administrative and other support services to affiliated medical groups. Providence Medical Institute is expected to grow significantly in the next several years, bringing with it facilities, staff and physician growth to support that objective.
For information on our comprehensive range of benefits, visit:
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.
Providence is a comprehensive not-for-profit network of hospitals, care centers, health plans, physicians, clinics, home health care and services continuing a more than 100-year tradition of serving the poor and vulnerable. 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.
Job Category: Patient Services
Location: California-Mission Hills
Req ID: 282819