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    Membership Coordinator - Los Angeles, United States - Preferred IPA of California

    Preferred IPA of California
    Preferred IPA of California Los Angeles, United States

    1 week ago

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    Description

    Job Description

    Job Description

    GENERAL SUMMARY

    The Membership Dept. is responsible for researching, adding, terming and updating member information in the Membership System and researching member eligibility in Health Plan and government agency websites to maintain accurate information in the Membership System.

    PRINCIPAL DUTIES AND RESPONSIBILITIES:

    • Research member eligibility for Claim and UM Departments when member information on claims or authorization requests is not found, or conflicts with information in the Membership System.
    • Responsible for obtaining member's current status of coverage(s), COB status, and name of IPA managing the member's care.
    • Add, update, terminate members in Membership system based on research, Health Plan notifications, and established Policies and procedures.
    • Link Document Control Number (assigned to scanned documents) to corresponding member in system. (Support Tech)
    • Assist PCPs with online Membership verification research requests.
    • Research COB coverage and update system accordingly.
    • Fax back Authorizations requests to providers if membership research indicates the member is not eligible through Preferred IPA.
    • Accurately and thoroughly document all research conducted in the appropriate EHP system notes.
    • Must have thorough knowledge of departmental policies and procedures, and companywide objectives.
    • Respond to membership eligibility questions from internal customers in a professional and courteous manner.
    • Adhere to HIPAA compliance standards
    • Meet and strive to increase productivity standards.
    • Ensure time sensitive work responsibilities are covered when not available.
    • Other duties may be assigned as needed.

    MINIMUM SKILLS/QUALIFICATIONS REQUIRED:

    • Excellent written, verbal, reading comprehension, and listening skills.
    • Experience conducting internet research to determine membership eligibility by accessing Health Plan and government agency websites.
    • Professional phone skills required for interaction with Health Plans and clients.
    • Ability to determine the Primary or Secondary payor based on research.
    • Excellent problem solving skills.
    • Provide management with feedback for ways to improve quality of service.
    • Ability to adapt to frequent operational changes and updates.
    • Ability to work in fast pace environment with minimal supervision and to prioritize and handle multiple projects.
    • Due to the nature of the department, must maintain excellent attendance and dependability.

    Education, Experience, and Training

    • Bachelor's degree in Business or related field; minimum three (3) years experience in Health Plan membership in a managed care environment; or equivalent combination of education and experience.
    • Knowledge of Federal Medicaid and/or California Medi-Cal programs.
    • Basic knowledge of medical terminology in a managed care environment.
    • Familiar with fax machines, and copiers.
    • Typing and word processing skills required.
    • Proficient in navigating through computer systems and conducting internet research.
    • Must be proficient in Word and Excel.

    CONFIDENTIAL AND SENSITIVE INFORMATION:

    • Must properly control the release of proprietary and confidential information

    Note that the information above is intended to describe the general nature and level of work being performed by employees, and are not to be construed as an exhaustive list of responsibilities, duties, and skills required of personnel so classified. Furthermore, they do not establish a contract for employment and are subject to change at the discretion of the employer.

    Company DescriptionThrifty Management Services is the dedicated MSO for Preferred IPA of California, providing the best possible care management, care coordination, and claims processing services to Preferred IPA and their members. We work with the network's participating physicians to coordinate patient care when a referral is made to a specialist or hospital for diagnosis and treatment. We coordinate patient care across all aspects of the provider network. We provide high quality services to its participating physicians and superior health care to its members.

    Company Description

    Thrifty Management Services is the dedicated MSO for Preferred IPA of California, providing the best possible care management, care coordination, and claims processing services to Preferred IPA and their members. We work with the network's participating physicians to coordinate patient care when a referral is made to a specialist or hospital for diagnosis and treatment. We coordinate patient care across all aspects of the provider network. We provide high quality services to its participating physicians and superior health care to its members.
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