Eligibility Specialist

Responsible for verifying PHP Group/IPA HMO members eligibility including coordination of benefits, linking employers groups with benefit products, auditing data in Data Wing Eligibility Manager for auto-load of members into EZ-CAP, reviewing eligibility for Priority UM Referrals/Claims which may require manual data entry of members current enrollment into EZ-CAP, working on various eligibility reports to eliminate duplicate members, correct bad addresses, contact unassigned members to assist with a PCP change; assist with PCP capitation audits/process, support Supervisor with P4P reports and provide support to IPA PCPs/others as necessary; with an emphasis on front-line eligibility problem solving. About PIH Health

PIH Health is a nonprofit, regional healthcare network that serves approximately 3 million residents in the Los Angeles County, Orange County and San Gabriel Valley region. The fully integrated network is comprised of PIH Health Downey Hospital, PIH Health Good Samaritan Hospital, PIH Health Whittier Hospital, 37 outpatient medical office buildings, a multispecialty medical (physician) group, home healthcare services and hospice care, as well as heart, cancer, digestive health, orthopedics, women’s health, urgent care and emergency services. The organization is nationally recognized for excellence in patient care and patient experience. About the Company

PIH Health Hospital - Downey is a non-profit community-based hospital located in Downey, California.

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