Membership Coordinator

1 week ago

Los Angeles, United States Preferred IPA of California Full time
Job DescriptionJob 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 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.

  • Membership Services Coordinator

    1 day ago

    Los Angeles, United States Hospital Association of Southern California Full time

    JOB INFORMATION Job Title Membership Services Coordinator Reports To Director, Membership Services Incumbent Last Updated 4/26/2024 SUMMARY Under general supervision and operating under established guidelines, this position will be (1) ensuring data integrity of all member accounts in the systemwide member databases; (2) support all aspects of the...

  • Procurement Coordinator

    5 days ago

    Los Angeles, United States University of California Full time

    Description The Semel Institute for Neuroscience and Human Behavior and the Department of Psychiatry & Biobehavioral Sciences aims to improve the mental health and wellbeing of the residents of California through professional education and training, translational research, and advancements in clinical care. To support that mission, the Semel Institute...

  • Procurement Coordinator

    1 week ago

    Los Angeles, United States University of California Full time

    DescriptionThe Semel Institute for Neuroscience and Human Behavior and the Department of Psychiatry & Biobehavioral Sciences aims to improve the mental health and wellbeing of the residents of California through professional education and training, translational research, and advancements in clinical care. To support that mission, the Semel Institute...

  • Relocation Project Coordinator

    Found in: Appcast Linkedin GBL C2 - 2 days ago

    Los Angeles, United States PM2CM, Inc. Full time

    Position Overview:Supports the Relocation Project Management (RPM) team at multiple campuses as needed in Furniture, Fixtures, and Equipment (FF&E) activities for all new, renovated and swing space projects which includes assistance in programming, specification, budget tracking, procurement coordination, scheduling with the construction team, installation,...

  • Care Coordinator

    1 week ago

    Los Angeles, United States Eisner Health Full time

    *This position requires travel within the San Fernando Valley*Position: Lead Care ManagerWho we are:We are a non-profit health center led by an inclusive team dedicated to improving the health and well-being of the community. Founded in 1920, Eisner Health has grown to provide integrated, culturally competent, and affordable healthcare at multiple locations...

  • Care Coordinator

    Found in: Appcast US C2 - 1 week ago

    Los Angeles, United States Eisner Health Full time

    *This position requires travel within the San Fernando Valley*Position: Lead Care ManagerWho we are:We are a non-profit health center led by an inclusive team dedicated to improving the health and well-being of the community. Founded in 1920, Eisner Health has grown to provide integrated, culturally competent, and affordable healthcare at multiple locations...

  • Care Coordinator

    Found in: Appcast Linkedin GBL C2 - 2 weeks ago

    Los Angeles, United States Eisner Health Full time

    *This position requires travel within the San Fernando Valley*Position: Lead Care ManagerWho we are:We are a non-profit health center led by an inclusive team dedicated to improving the health and well-being of the community. Founded in 1920, Eisner Health has grown to provide integrated, culturally competent, and affordable healthcare at multiple locations...

  • Regional Coordinator

    1 week ago

    Los Angeles, United States National Fire Sprinkler Association Full time

    Job Type Full-time Description The Regional Coordinator based in the Los Angeles area exists to support team efforts in achieving the vision and fulfilling the mission of the NFSA as well as enhancing effectiveness and efficiency at all levels of the organizations. The Regional Coordinator works within NFSA's National Industry Promotion Programs to serve...

  • Relocation Project Coordinator

    Found in: Resume Library US A2 - 1 week ago

    Los Angeles, California, United States PM2CM Full time

    Position Overview: Supports the Relocation Project Management (RPM) team at multiple campuses as needed in Furniture, Fixtures, and Equipment (FF&E) activities for all new, renovated and swing space projects which includes assistance in programming, specification, budget tracking, procurement coordination, scheduling with the construction team,...

  • Program Coordinator

    2 weeks ago

    Los Angeles, United States YMCA of Metropolitan L.A. Full time

    Job DescriptionJob DescriptionThe YMCA of Metropolitan Los Angeles is not only the premiere non-profit in Los Angeles, it is also a great place to work, make a difference in your community and meet like-minded individuals. With twenty-six branches, three camps and over fifty child care sites, the LA Y is a highly-collaborative, rewarding and fun environment...

  • WWK Care Coordinator

    5 days ago

    Los Angeles, United States Allies for Every Child Full time

    Job Description Job Description #BECOMEANALLYTODAY! $2500 SIGN-ON INCENTIVE BONUS (new hires) PAY RANGE: $22.00 - $26.00 per hour (In accordance with California law, the expected salary range for this California position. The actual compensation will be determined based on experience and other factors permitted by law.) FOR CONSIDERATION : Email cover letter...

  • WWK Care Coordinator

    7 days ago

    Los Angeles, United States CareerBuilder Full time

    Job Description Job Description #BECOMEANALLYTODAY! $2500 SIGN-ON INCENTIVE BONUS (new hires) PAY RANGE: $22.00 - $26.00 per hour (In accordance with California law, the expected salary range for this California position. The actual compensation will be determined based on experience and other factors permitted by law.) FOR CONSIDERATION : Email cover letter...

  • WWK Care Coordinator

    1 week ago

    Los Angeles, United States Allies for Every Child Full time

    Job DescriptionJob Description#BECOMEANALLYTODAY!$2500 SIGN-ON INCENTIVE BONUS (new hires)PAY RANGE: $22.00 - $26.00 per hour (In accordance with California law, the expected salary range for this California position. The actual compensation will be determined based on experience and other factors permitted by law.)FOR CONSIDERATION: Email cover letter and...

  • Program Coordinator RN

    Found in: Talent US C2 - 2 weeks ago

    Los Angeles, United States Providence Full time

    The individual in this position is responsible for:  • Assisting in all aspects of the ANCC Magnet/Pathway application, designation, and re-designation process and professional practice within the region. • Collaborating with the regional, service area, and ministry nursing and interprofessional leaders to develop, implement, evaluate, and track the...

  • Sales Manager

    1 week ago

    Los Angeles, United States sulekha.co.uk Full time

    Sales Manager Jobs in San Francisco, CA *Work Experience***15 - 20 Years** *Job Role* **Sunil Kumar** Sales Manager 2 hrs ago Job Description: An Indian multinational FMCG packaged food company is looking for a Sales & Marketing Manager with minimum of 15 years of sale... We are currently seeking to hire a National **Sales** **Manager** - Vehicle Video and...

  • Part-Time Member Service Representative

    1 week ago

    Los Angeles, United States The Young Turks Full time

    **** **Part-Time Member Service Representative** Los Angeles, CA preferred, PM PST hours required **Industry** Membership, Customer Service **Duration** Regular,Part-Time **Company Description** Summary - 30 hours per week We are looking for a dedicated, Customer Support Representative who will be able to provide exceptional customer support to our members....

  • Community Affair Department Manager, Los Angeles, CA Full time

    4 days ago

    Los Angeles, United States Cielo Full time

    CIELO’s community outreach team is critical in creating access and supporting navigating resources. Your role as part of the community outreach team will be integral to providing access to necessary resources and services to Indigenous communities. You will work closely with the outreach team and the Indigenous migrant communities. Description Roles and...

  • Director of Operations

    Found in: Talent US 2 C2 - 1 week ago

    Los Angeles, United States Los Angeles County Bar Association Full time

    The Los Angeles County Bar Association (LACBA) is seeking our next Director of Operations and Legal Affairs, this is a hybrid position 80% remote and 20% in the office. The ideal candidate should be a licensed attorney familiar with employment, contracts, and non-profit legal matters to coordinate projects with our outside counsel. Responsibility for...

  • Asbestos Attorney

    Found in: Appcast Linkedin GBL C2 - 2 weeks ago

    Los Angeles, United States Ascendion Full time

    Seeking an experienced Asbestos Attorney, specializing in toxic tort and product liability cases. This role is tailored for a seasoned professional who has demonstrated expertise in handling complex asbestos-related litigation, with a deep understanding of toxic torts, environmental law, and product liability. Key Responsibilities:Handle a caseload of...

  • Asbestos Attorney

    1 week ago

    Los Angeles, United States Ascendion Full time

    Seeking an experienced Asbestos Attorney, specializing in toxic tort and product liability cases. This role is tailored for a seasoned professional who has demonstrated expertise in handling complex asbestos-related litigation, with a deep understanding of toxic torts, environmental law, and product liability. Key Responsibilities:Handle a caseload of...