Providence is calling an Eligibility Coordinator I ( Full Time / Day Shift ) to our Facey Eligibility Office location in Mission Hills, CA.
In this position you will:
Review daily EDI provider claims loaded into IDX based on eligibility guidelines and EDI toolkit requirements.
Respond to and resolve all exceptions found in the EDI toolkit immediately.
Review and process provider claims based on provider and health plan contractual agreement, claims processing and reimbursement guidelines, and company policies and procedures.
Respond to and resolve provider and health plan claims inquiries and apply resolution in a timely fashion.
Maintain departmental standards on productivity and quality of work.
Required qualifications for this position include:
Two or more years HMO claims processing experience required in an IDX computer-based managed care environment, preferably PMG/IPA setting within the last three years or any combination of education and/or experience which produces an equivalency.
Knowledge of medical terminology and coding and patient eligibility guidelines.
Familiar with CMS and Department of Managed Care mandates.
Proficient use of CRT keyboard.
Ability to type 35 WPM.
Uses a ten-key adding machine, perform data entry and make mathematical calculations.
Effective communication and follow-through skills.
Preferred qualifications for this position include:
Bilingual Spanish preferred
About the organization you will serve:
Facey Medical Group is a multi-specialty medical group with over 160 physicians providing care to the growing population in the North & East regions of Los Angeles & Ventura Counties. Twelve medical clinics, including two urgent care centers and dedicated women's centers, are located across the San Fernando, Santa Clarita, and Simi Valleys. The group began as a single medical practice over 90 years ago.
Facey is part of Providence Health & Services, an integrated, not-for-profit 5-state network of hospitals, care centers, medical clinics, affiliated services and educational facilities spanning from California to Alaska.
We offer a full comprehensive range of benefits - see our website for details
As people of Providence, we reveal God's love for all, especially the poor and vulnerable, through our compassionate service.
Providence Health & Services is the third largest not-for-profit health system in the United States. Providence employs more than 82,000 caregivers (employees) across a five-state area; AK, WA, MT, OR, and CA. Our facilities include 34 hospitals, 600 physician clinics, senior services, supportive housing and other health and educational services. 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.