Eligibility/Benefits Representative

High Desert Medical Group • Lancaster, CA

20h • $21 - $29

About The Position

High Desert Medical Group is seeking a full-time Eligibility/Benefits
Representative who will be responsible for processing eligibility and benefits
data manually and electronically with attention to detail and accuracy and
investigate eligibility discrepancies utilizing all resources at hand.

Requirements

• High school graduate or equivalent.
• Minimum one-year experience in a medical group working with a 3rd party insurance and date processing desirable.
• Excellent written, verbal, and interpersonal communication skills.
• Ability to handle and prioritize tasks in order to meet all given deadlines and productivity goals.
• Ability to responsibly handle matters of a confidential nature.
• Ability to work in a multi-task, high-productive environment.

Responsibilities

• Process new, termed, and update exiting member eligibility records in EZ-Cap according to established guidelines.
• Electronically and manually audits existing eligibility in EZ-Cap against current health plan reports and updates EZ-Cap according to established guidelines.
• Investigates retroactive cancellations for services rendered to the member after the policy termination date for eligibility guarantee and provides documentation to Claims department.
• Researches eligibility and benefit questions for other departments and relating to health plan reports through normal channels utilizing both health plan websites and telephone contact with health plans.
• Uses Eligibility Manager (EM) to electronically audit existing eligibility in EZ-Cap against current eligibility provided by health plan.
• Assists personnel from other departments with eligibility and benefit issues.
• Communicates with management on any eligibility changes that could impact the group/providers financially.
• Follow and adhere to HDMG's standards of attendance policy, as it is pertinent to be available to process new, termed, and update member eligibility records.
• Perform other duties as assigned.

Benefits

• a full range of medical, financial, and/or other benefits (including 401(k) eligibility and various paid time off benefits, such as vacation, sick time, and parental leave)

What This Job Offers

• Job Type: Full-time
• Career Level: Entry Level
• Education Level: High school or GED