Eligibility and Provider Coordinator
About The Position
The Eligibility Provider Coordinator supports accurate setup, maintenance, and ongoing updates of provider and member eligibility data across internal systems. This position focuses on high-volume data entry, file processing, and routine data reviews to ensure information is complete, compliant, and up to date. The coordinator assists the Provider Analyst with provider configuration tasks, fee schedule updates and research. The role also supports daily eligibility operations by processing member updates, auditing data, and resolving issues to maintain data integrity and timely workflows.
Requirements
- High school diploma or equivalent
- At least three years of experience in managed care eligibility, provider, or healthcare administrative operations.
- Knowledge of provider data structures and healthcare provider information requirements.
- Working knowledge of managed care operations, provider networks, credentialing processes, and basic claims concepts.
- Knowledge of healthcare eligibility and enrollment processes within managed care, health plan, or insurance environments.
- Understanding of member data elements, including demographics, plan assignments, PCP selections, enrollment effective dates, rosters, and 834 eligibility files.
- Proficiency with EZ-CAP or similar managed care or claims administration systems, with the ability to quickly learn new systems, tools, and technologies.
- Knowledge of HIPAA privacy requirements and appropriate handling of confidential provider and member information.
- Strong data entry skills with a high degree of accuracy and attention to detail in high-volume environments.
- Ability to validate and compare data across systems and identify missing, inconsistent, or inaccurate information.
- Ability to perform routine audits, reconciliations, and quality assurance reviews to maintain provider and eligibility data integrity.
- Ability to maintain accurate and organized system configuration records and supporting documentation.
- Strong critical-thinking and problem-solving skills, with the ability to research and resolve routine provider and eligibility data discrepancies using established procedures.
- Effective written and verbal communication skills with the ability to interact professionally and maintain confidentiality.
- Strong organizational and time-management skills with the ability to manage multiple priorities, deadlines, and documentation requirements.
- Ability to consistently follow established procedures, workflows, departmental standards, and regulatory requirements.
Nice To Haves
- Associate’s degree or college coursework in Healthcare Administration, Business, or related field.
- Experience in managed care, MSO, IPA, or health plan environment; familiarity with member eligibility, eligibility files and providers (e.g., EZ-Cap)
Responsibilities
- Supports accurate setup, maintenance, and ongoing updates of provider and member eligibility data across internal systems.
- Focuses on high-volume data entry, file processing, and routine data reviews to ensure information is complete, compliant, and up to date.
- Assists the Provider Analyst with provider configuration tasks, fee schedule updates and research.
- Supports daily eligibility operations by processing member updates, auditing data, and resolving issues to maintain data integrity and timely workflows.
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Education Level
High school or GED
