Coordinator,Eligibility-IPA Op
Job description
The Eligibility Coordinator- IPA Operations is primarily responsible for maintaining the Eligibility: Claims, Authorization and Customer Service Related Work Queues and ensuring that the required TAT times are met and in compliant with Health Plan requirements and guidelines. The position requires verifying, resolving and updating health plan data vs EZCap eligibility data as well as maintaining the Eligibility Phone queues and the monthly mailing of Eligibility and Capitation documents.
Responsibilities:- Understand, adhere to and implement company and department policies and procedures.
- Verify Member Eligibility Data via Plan Website or phone verification.
- Perform manual Adds, Terms, Retro, PCP changes and member demographic changes in EZCap.
- Work and maintain Eligibility: Claims, Authorization and Customer Service Work Queues and emails.
- Work on Member Can’t Find Requests.
- Researches on problem eligibility data discrepancies.
- Maintain Eligibility Phone Queues.
- Perform monthly mailing of Capitation and Eligibility Documents.
- Special Projects as assigned by Managed Care Capitation and Eligibility Manager.
- Other Duties as assigned by Managed Care Capitation and Eligibility Manager.
- High School Diploma or equivalent required.
- Minimum of 1 year experience of Health Plan Eligibility Verification or 1 year related experience or training in the medical/insurance claims industry.
- Minimum of 1 year data entry required.
- EZCAP experience preferred but not required.
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