We are hospitals and affiliated medical groups, working closely together for the benefit of every person who comes to us for care. We build comprehensive networks of quality healthcare services that are designed to offer our patients highly coordinated, personalized care and help them live healthier lives. Through collaboration, we strive to provide all of our patients and medical group members with the quality, affordable healthcare they need and deserve.

The Senior Eligibility Processor is responsible for the activities related to the process of uploading Health plan eligibility files to Prospect’s core system (IDX), for the purpose of managing eligibility information. This role requires someone to function with a high degree of independence, dependability, and data entry accuracy. The position is responsible for the daily operational activities which will ensure successful and accurate inbound and outbound transmissions.

Job Requisition

• Meet with health plan and vendor(s) on issues with health plan file data. Articulate eligibility issues and processes with health plan/vendor contacts and management. Perform testing and troubleshooting on new or updated health plan files. Establish processes for new health plan files.
• Generate audit reports and guide Eligibility Team on working audit reports work queues for assigned health plan. Research identified issues and escalate errors to the appropriate departments. Ensure that operational duties will meet or exceed all relevant stated Service Level Agreements (SLA). Train new hires as a subject-matter expert on Eligibility processes.
• Actively participate in supporting special projects as requested. Complete variety of projects of an analytical nature as assigned by management or identified through own work.
• Administer all aspects of health plan eligibility file loads into eligibility management software and IDX, including eligibility file setup, data integrity analysis, field mapping, and implementation of network affiliation and plan codes. Maintain accuracy in working within eligibility management software and IDX. Perform Monthly Reconciliations to ensure variances from the health plan files to IDX are <=1% variance or <= 50-member difference. Work directly with health plans and vendor contacts on issues involving health plan files and data integrity.
• The Senior Eligibility Processor is responsible for the activities related to the process of uploading Health plan eligibility files to Prospect’s core system (IDX), for the purpose of managing eligibility information. This role requires someone to function with a high degree of independence, dependability, and data entry accuracy. The position is responsible for the daily operational activities which will ensure successful and accurate inbound and outbound transmissions.

Qualifications

Minimum Education: High School Diploma/BA, or equivalent work experience.

Minimum Experience: Experience operating PC-based software programs. 4+ years working within Enrollment/Eligibility for a health plan, IPA, Medical Group, or Provider Office. Experience using SQL and Access databases and other software applications within Enrollment/Eligibility. Experience working within IDX a plus. Experience pulling files via health plan websites, SFTP, and e-mail.

Req. Certification/Licensure: NONE

Employee Value Proposition

Prospect Medical Holdings, Inc., is guided by a diverse and highly experienced leadership core. This group maintains the vision that has made Prospect a needed difference-maker in the lives of so many patients today, and many executives contribute to our continued efforts. As a member of our highly effective team of professionals, benefit eligible positions will receive:

• Paid time-off
• Medical, dental, vision insurance
• Company 401K
• Life insurance

How to Apply

To apply for this role, or search our other openings, please visit http://pmh.com/careers/ and click on a location to begin your journey to a new career with us!

We are an Equal Opportunity/ Affirmative Action Employer and do not discriminate against applicants due to veteran status, disability, race, gender, gender identity, sexual orientation or other protected characteristics. If you need special accommodation for the application process, please contact Human Resources.

EEOC is the Law: https://www.eeoc.gov/