Eligibility Coordinator

ProCare Rx Career • Gainesville, GA

9d

About The Position

The Eligibility Coordinator is responsible for a variety of tasks related to member eligibility, including inputting information for new groups, assisting with client implementation, and coordinating with client contacts to ensure accurate and timely information. This role also involves managing online user accounts, enrolling new members, processing terminations, and working with multiple departments to meet eligibility requirements. The coordinator will utilize both manual and systematic enrollment processes, review daily reports for corrections, and handle escalated eligibility issues. Maintaining eligibility files, ensuring system updates and data integration, and performing scheduled reviews and quality assurance are also key duties. Additional responsibilities may include assisting with go-lives, testing data files, member communications, personal importation, overflow phone support, and pharmacy network tasks.

Requirements

• High school diploma or equivalent required
• Minimum three years experience in a customer service position, preferably as an Office Manager or a similar service position in the health care industry
• Must have excellent communication skills and the ability to work effectively with clients, pharmacies, and plan members, internal and external contacts
• Proficient PC skills in Windows-based applications
• Ability to be flexible and quickly adapt to changing needs in department
• Must be highly organized with strong attention to detail
• Must be flexible with scheduled work hours

Nice To Haves

• Post high school or specialized training in medical field desired
• Health insurance background and knowledge of pharmacy terminology desired

Responsibilities

• Coordinates the input of member eligibility for all new groups
• Assists with the implementation process for new clients
• Coordinates with client contacts to ensure information is received is accurate and timely
• Enrolls on-line management (Portal) users and maintains accounts
• Enrolls new members and/or processes terminations
• Works with multiple departments to coordinate eligibility requirements
• Utilizes both manual and systematic enrollment process
• Reviews daily reporting for eligibility corrections
• Answers incoming telephone calls related to eligibility needs
• Ensures eligibility systems are updated and data is appropriately integrated on a daily basis
• Maintains the eligibility files for medical coverage recipients (PHI)
• Handles escalated eligibility issues to ensure problems are resolved
• Ensures that all correspondence and eligibility files are properly maintained
• Perform scheduled review and quality assurance for member eligibility
• Assist with go-lives and testing data files
• Performs various related duties as assigned including but not member communications, personal importation, overflow IC phone support, pharmacy network tasks; etc.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: High school or GED