Health Information Coordinator

5 days ago


Monterey, California, United States Astrana Health Full time
About the Role

Astrana Health is seeking a highly organized and detail-oriented Health Plan Information Specialist to join our team. As a key member of our Eligibility department, you will be responsible for organizing, maintaining, and updating Ez-Cap eligibility information, ensuring members' eligibility is up-to-date, and handling conflicts and rejections related to members' eligibilities.

Responsibilities
  • Assume day-to-day administrative responsibilities related to Eligibility, including managing diverse areas of understanding and interfacing effectively with all employees, members, employers, HMO personnel, and providers.
  • Contact various health plans to verify member eligibility with the plans and IPA's, and download and maintain data from Health Plan either through websites, discs, FTP sites, or 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, and 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, and research member additional insurance such as dual, Medicare, Medi-Cal, and CCS, documenting in Ez-Cap.
  • Run and create reports of members assigned to non-contracted providers, and 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, and 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 to Have
  • Typing speed 50+WPM and knowledge of 10-key preferred.
About Astrana Health

Astrana Health 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.

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.

We are proud to be an Equal Employment Opportunity and Affirmative Action employer, and 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.



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