Maintain Provider, Network, and Member entries in Prospect's core system (IDX) by reviewing eligibility in IDX against health plan websites to verify member and provider information and entering in changes to eligibility postings in IDX. Resolve assigned accounts from work queues within IDX and internal email requests.
ResponsibilitiesMaintain Provider, Network, and Member entries in Prospect's core system (IDX) by reviewing eligibility in IDX against health plan websites to verify member and provider information and entering in changes to eligibility postings in IDX. Resolve assigned accounts from work queues within IDX and internal email requests.Place outgoing calls to providers and health plans to resolve eligibility issues. Cover phone lines for incoming calls from providers for eligibility inquiries as needed.Research Customer Service inquiries regarding eligibility and provide responses in a timely manner. Document changes in member detail in the Customer Service Module (CSR). Escalate issues to management and the appropriate internal departments.Actively participate in supporting special projects as assigned by management.QualificationsMinimum Education: High School Diploma or equivalent.
Minimum Experience: Two (2) years working for a health plan, IPA, Medical Group, or Provider Office. Experience operating PC-based software programs.
Req. Certification/Licensure: None
About UsWith approximately 9,000 physicians to serve our 260,000 members, Prospect Medical Systems is proud to be among the most innovative medical systems in California, Texas, and Rhode Island. Our extensive care services range from primary care and specialty physician services to acute care hospital and skilled nursing facilities to behavioral health and wellness services. Each of our Independent Physician Associations (IPAs) and networks support the use of advanced diagnostic and treatment tools to provide our members with convenient access to state-of-the-art healthcare. For 25+ years, Prospect Medical has been focused on our mission of supporting independent physicians where, through risk arrangements, we work closely together with health plans, facilities, and healthcare physicians for the benefit of every person who comes to us for care. We provide quality healthcare services that are designed to offer our patients highly coordinated, personalized care and that help them live healthier lives. Prospect Medical Systems manages highly successful IPAs by leveraging our best-practices, results-driven administrative services to manage patients under risk arrangements with health plans/CMS.
Job InfoJob Identification: 3892Job Category: Health PlansPosting Date: 10/28/2024, 07:04 AMDegree Level: High School GraduateJob Schedule: Full timeJob Shift: DayLocations: 600 City Parkway West, Orange, CA, 92868, US (Remote)
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