Eligibility Specialist

Job Description

Job Description

Salary : $20-$40 / hourly DOE

TITLE : Eligibility Specialist

DEPARTMENT : Operations

Bloom Value Corporation

www.bloomvalue.com

Bloom Value Corporation is a technology start up based in Sacramento, CA, USA. Founded by a diverse group of IT industry and healthcare leaders, Bloom Value is focused on financial and operational value optimization. Our founders include Enterprise AI pioneers, Finance and Operations experts, Change Management experts and Physicians. The team has Research, Development and Consulting experience across a broad range of industries and provider institutions.

Bloom is developing a unique AI platform for Healthcare Finance and Operations Optimization. Blooms solutions enable Healthcare C-suite to gain full glass box visibility, benchmarking, exception management and proactive optimization across multiple areas of healthcare finance

POSITION SUMMARY

The Eligibility Specialist analyzes, reviews, and oversees the eligibility lifecycle. Starting with loading all eligibility files to completing an analysis of members who have terminated with IPAs under management. All eligibility updates / requests are expedited and must be handled within 24 hours. The ideal candidate is dependable, detail oriented, and has a strong work ethic.

The Eligibility Specialist is responsible for :

• Ensuring proper loading of all Health Plan eligibility and capitation files
• Updating the members eligibility as requested
• Redetermination review with applicable Health Plans
• Coordinate with the Health Plan on needed changes / updates
• Loading new benefits each year and as needed
• Analyzing member termination reports and identifying any trends
• Identifying and correcting members addresses from returned mail
• All other duties as assigned

SPECIFIC SKILLS NEEDED

EDUCATION / EXPERIENCE / TRAINING