Job description
Overview
Dignity Health Medical Foundation established in 1993 is a California nonprofit public benefit corporation with care centers throughout California. Dignity Health Medical Foundation is an affiliate of Dignity Health - one of the largest health systems in the nation - with hospitals and care centers in California Arizona and Nevada. Today Dignity Health Medical Foundation works hand-in-hand with physicians and providers throughout California to provide comprehensive health care services to the many communities we serve. As Dignity Health Medical Foundation continues to grow and establish new premier care centers we provide increasing support and investment in the latest technologies finest physicians and state-of-the-art medical facilities. We strive to create purposeful work settings where staff can provide great care while advancing in knowledge and experience through challenging work assignments and stimulating relationships. Our staff is well-trained and highly skilled qualities that are vital to maintaining excellence in care and service.
Responsibilities
Position Summary:
The position has hands-on accountability for the processing of electronic enrollment files for Dignity Health Medical Foundation. The position is responsible for timely and accurate input of benefit plan details in IDX/GE Centricity Business (GECB)/athenaIDX. This position is responsible for maintaining the integrity of the membership and benefits database, maintaining a tight relationship between IDX and the health plan rosters. This includes coordinating with health plans to ensure timely updates to eligibility/benefit files as well as the actual processing of those files in the Managed Care system. Develops, recommends and coordinates the implementation of new procedures and ensures the efficient utilization of the IDX benefit and enrollment databases. Communicates effectively on membership and benefit issues with the Manager, Member Services. This position is challenged to optimize the use of the information system and related benefit and membership database so that processes are done efficiently and accurately. This requires in-depth understanding of the information system functionality as well as an understanding of clinic and business office operations.
Qualifications
Minimum Qualifications:
Preferred Qualifications:
Dignity Health Medical Foundation established in 1993 is a California nonprofit public benefit corporation with care centers throughout California. Dignity Health Medical Foundation is an affiliate of Dignity Health - one of the largest health systems in the nation - with hospitals and care centers in California Arizona and Nevada. Today Dignity Health Medical Foundation works hand-in-hand with physicians and providers throughout California to provide comprehensive health care services to the many communities we serve. As Dignity Health Medical Foundation continues to grow and establish new premier care centers we provide increasing support and investment in the latest technologies finest physicians and state-of-the-art medical facilities. We strive to create purposeful work settings where staff can provide great care while advancing in knowledge and experience through challenging work assignments and stimulating relationships. Our staff is well-trained and highly skilled qualities that are vital to maintaining excellence in care and service.
Responsibilities
Position Summary:
The position has hands-on accountability for the processing of electronic enrollment files for Dignity Health Medical Foundation. The position is responsible for timely and accurate input of benefit plan details in IDX/GE Centricity Business (GECB)/athenaIDX. This position is responsible for maintaining the integrity of the membership and benefits database, maintaining a tight relationship between IDX and the health plan rosters. This includes coordinating with health plans to ensure timely updates to eligibility/benefit files as well as the actual processing of those files in the Managed Care system. Develops, recommends and coordinates the implementation of new procedures and ensures the efficient utilization of the IDX benefit and enrollment databases. Communicates effectively on membership and benefit issues with the Manager, Member Services. This position is challenged to optimize the use of the information system and related benefit and membership database so that processes are done efficiently and accurately. This requires in-depth understanding of the information system functionality as well as an understanding of clinic and business office operations.
Qualifications
Minimum Qualifications:
Significant hands-on experience in the application of automated Managed Care System including benefits, membership, authorizations, and claim adjudication is required as well as an understanding of clinic and busines office operations.- High School diploma required.
- Exhibits an understanding of the responsibilities related to enrollment and/or benefit processing.
- Observes policies and procedures related to confidentiality of patient information.
- Ability to use PC based computer software (e.g. Microsoft Windows, Word, Excel and Outlook).
- Familiarity with IDX (or comparable Managed Care System) is required.
Preferred Qualifications:
One (1) year of related experience in the healthcare industry is strongly preferred.
- Experience with claims or invoice process (adjudication). Understanding of how the system works, when and how to apply member benefits.
- Knowledge and understanding of how HMO/Managed Care works
- Experience in obtaining, intrepertiping, and building HMO member benefits using the information provided by the Health Plans.
- Experience with, or understanding of, Member Out of Pocket Max (MOOP) and Member Deductible.
- Experience with, or understanding of, Division of Financial Responsibility (DOFR)
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