Title: Health Plan Information Specialist
Department: Eligibility
About the role:
Organizes, maintains, and updates Ez-Cap eligibility information. Uses company proprietary software (Eligibility Manager and Health Plan Sphere) applications to process membership. Ensures members' eligibility is up-to-date in Ez-Cap from contracted Health Plans, checks health plan websites and contacts Medi-Cal and Medicare offices. Handles checking eligibility, benefits, co-pays for authorization and claims department. Tracks work by keeping accurate logs of all the different projects of maintaining member eligibility. Working on conflicts and rejections related to members' eligibilities. In charge of in-loading membership in Ez-Cap for multiple contracted IPA's. Creates and runs ad-hoc reports for membership and other data information. Supports other various projects as assigned by manager.
Responsibilities:
- Assume day-to-day administrative responsibilities related to Eligibility.
- Manage diverse areas of understanding and interface effectively with all employees, members, employers, HMO personnel, and providers.
- Contact various health plans to verify member eligibility with the plans and IPA's.
- Download and maintain data from Health Plan either through website, discs, ftp sites, and any other ways data is transmitted.
- Perform high-level eligibility reconciliation, reviewing all Eligibility Manager filters and resolving missing members prior to exporting to the EZ-EDI software.
- Check membership from various sources using Health Plan Sphere, checking websites manually, or calling health plans directly.
- Assist the claims department to verify eligibility and benefits for co-pay.
- Assist with EDI and Member Can't find of claims sent in from providers.
- Important to exhaust research all possibilities verifying members' IPA affiliation.
- Assist with case investigation of members' previous IPA's.
- Research member additional insurance such as dual, Medicare, Medi-Cal, and CCS. Document in Ez-Cap.
- Run and create reports of members assigned to non-contracted providers.
- Other duties may be assigned.
- Must be able to work in a fast-paced environment effectively and efficiently.
- Understand and abide by all departmental and organizational policies and procedures. Maintain HIPAA security as it relates to job duties.
- Recognize and respond to priorities, accept changes and new ideas. Have insight into problems and the ability to develop workable alternatives.
Qualifications:
- Intermediate knowledge of MS Word, Excel, Access, and basic medical terminology is required.
- Ability to understand and work with proprietary software applications.
- Organizational ability and ability to exercise good judgment.
- Basic math and calculation is required.
- One to two years related experience and/or training; or equivalent combination of education and experience.
Nice If You Have:
- Typing speed 50+ WPM and knowledge of 10 key preferred.
Who We Are:
Astrana Health (NASDAQ: ASTH) is a physician-centric, technology-powered healthcare company accelerating the path towards a future where high-quality, coordinated healthcare is available to all. We are building and operating an integrated, value-based healthcare delivery platform to empower our physicians to provide the highest quality of end-to-end care for their patients in a cost-effective manner, especially patients who are traditionally underserved and those most vulnerable.
Our platform currently empowers over 10,000 physicians to provide care for ~1 million patients nationwide and is growing revenue over 40% a year. We have demonstrably improved patient outcomes: seniors on our platform spend 54% fewer days in the hospital than the national average and are readmitted 63% less often, and serve an extremely diverse community, with over 75% of our patients identifying as BIPOC and over 80% enrolled in Medicare or Medicaid.
Our rapid growth and unique position at the intersection of all major healthcare stakeholders (payer, provider, and patient) gives us an unparalleled opportunity to combine clinical and technological expertise to improve patient outcomes, increase access to quality healthcare, and reduce the waste in the US healthcare system.
Our Values:
- Put Patients First
- Empower Entrepreneurial Provider and Care Teams
- Be Innovative
- Operate With Integrity & Excellence
- Work As One Team
Environmental Job Requirements and Working Conditions:
- This position is based in our Monterey Park Corporate Office.
- The annual total compensation target pay range for this role is: $58,000 - $73,000. This salary range represents our national target range for this role.
Additional Information:
Astrana Health is proud to be an Equal Employment Opportunity and Affirmative Action employer. We do not discriminate based upon race, religion, color, national origin, gender (including pregnancy, childbirth, or related medical conditions), sexual orientation, gender identity, gender expression, age, status as a protected veteran, status as an individual with a disability, or other applicable legally protected characteristics. All employment is decided on the basis of qualifications, merit, and business need. If you require assistance in applying for open positions due to a disability, please email us at humanresourcesdept@astranahealth.com to request accommodation.
The job description does not constitute an employment agreement between the employer and employee and is subject to change by the employer as the needs of the employer and requirements of the job change.
