People are the most important asset of Imperial, for this reason the difference and plurality of people, equality of opportunities, non-discrimination and inclusion in the workplace are priority and strategic factors in the Organization. Imperial maintains a strong will to promote Diversity, Equity, and Inclusion, through inclusive leadership as a lever change and business sustainability.
Imperial Health Plan of California, Inc., is licensed by the California Department of Managed Health Care as a health care service plan in accordance with the Knox-Keene Act to provide Medicare Advantage covered services, including a Medicare Advantage Prescription Drug plan, and a Chronic Condition Special needs plan over numerous counties in California. Through its affiliates, Imperial Insurance Companies, Inc., and Imperial Health Plan of the Southwest, Inc., it also offers individual marketplace covered services in Texas, Utah, Nevada and Arizona.
Our Mission: To deliver valuable care so that members are healthy in body, mind, and spirit to achieve their inherent potential.
Our Vision: To deliver value based care that is clinically effective, sustainable, and achieves exceptional outcome.
JOB SUMMARY: Responsible for reconciling eligibility and capitation payments from CMS and Health plans. Prepare capitation reports for delegated IPAs. Coordinate with finance to facilitate monthly capitation payments.
ESSENTIAL JOB FUNCTIONS:
1. Serve Capitation processing: including cap deductions, flat capitation payments, monthly capitation compile, posting, and analysis, audit IPA capitation report and make sure the rates are according to the PCP contracts.
2. Assume day-to-day administrative responsibilities related to Eligibility.
3. Contact various health plans to verify member eligibility with the plans and IPA's.
4. Maintain data from Health Plan either through website, discs and any other ways data is transmitted.
5. Monthly rejects and conflicts for members that needed to be added and termed in the system for monthly capitation run.
6. Assists the Claims Department to verify eligibility and other health coverage from the health plans.
7. Assists with daily phone queue from providers, members and vendors related to eligibility and capitation.
8. Manually input new providers' membership not on E-list.
9. Fixes EDI errors of "Member Can't Find".
EDUCATION/EXPERIENCE: • High school graduate or equivalent. • 2 yrs. EZ-Cap exp
SKILLS/KNOWLEDGE/ABILITY: • Knowledge of managed care and HMO products • Proficient in Microsoft products specially in Excel • Handles phone calls professionally and courteously