Company: Apollo Medical Holdings, Inc.
Location: El Monte
Posted on: May 3, 2021
SUMMARY Organizes, maintains, and update Ez-Cap eligibility
information. Makes sure members' eligibility is up-to-date in
Ez-Cap from contracted Health Plans, checks health plan web sites
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 rejects related to members' eligibility. Assists
internal representatives with any eligibility questions. Support
other various projects as assigned by lead or director. ESSENTIAL
DUTIES AND RESPONSIBILITIES, include the following:
- Assume day-to-day administrative responsibilities related to
- Contact various health plans to verify member eligibility with
the plans and IPA's.
- Download and maintain data from Health Plan either through web
site, discs, ftp sites and any other ways data is Transmitted.
- Check membership from various sources using Datatug, checking
web sites manually, or calling health plans directly.
- Monthly rejects and conflicts for members that needed to be
added and termed in the system for monthly capitation run.
- Assists the claims department to verify eligibility and other
health coverage from the health plans.
- Assists with EDI and Member Can't find of claims sent in from
- Assists with daily phone queue from providers, members and
vendors related to eligibility and capitation.
- Research member additional insurance such as dual, Medicare,
Medi-Cal, and CCS. Document in Ez-Cap.
- New providers' membership not on E-list will be manually
- Other duties may be assigned. QUALIFICATIONS To perform this
job successfully, an individual must be able to perform each
essential duty satisfactorily. The requirements listed below are
representative of the knowledge, skill, and/or ability required.
Reasonable accommodations may be made to enable individuals with
disabilities to perform the essential functions.
- Intermediate knowledge of MS Word, Excel, Access and basic
medical terminology is required.
- Ability to understand and work with proprietary software
- Organizational ability and ability to exercise good
- Typing speed 40+WPM and knowledge of 10 key desired. EDUCATION
and/or EXPERIENCE One to two years related experience and/or
training; or equivalent combination of education and experience.
Bachelor's degree (B.A.) from four-year College or university will
be suitable as well.
Keywords: Apollo Medical Holdings, Inc., El Monte , Eligibility Coordinator, Other , El Monte, California
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