Eligibility Operations Coordinator

Astiva Health•Orange, CA

6d•$25 - $29•Onsite

About The Position

Astiva Health, Inc., located in Orange, CA is a premier healthcare provider specializing in Medicare and HMO services. With a focus on delivering comprehensive care tailored to the needs of our diverse community, we prioritize accessibility, affordability, and quality in all aspects of our services. Join us in our mission to transform healthcare delivery and make a meaningful difference in the lives of our members. The Eligibility Operations Specialist maintains accurate member eligibility data, manages C SNP verification, and supports compliance-driven tasks through timely processing of member data and Medicare Secondary Payer (MSP) activities. The role serves as a key liaison across internal teams, providers, and regulatory systems to ensure adherence to CMS requirements.

Requirements

High school diploma or equivalent required
Minimum 2+ years’ experience with Medicare Advantage required
Excellent verbal and written communication skills.
Strong organizational skills with the ability to manage multiple priorities and regulatory deadlines while maintaining accuracy.
Demonstrate the ability to work independently and prioritize workload while maintaining accuracy and productivity.
Ability to identify issues, determine appropriate next steps and seek guidance when necessary.
Proficient in Microsoft Office applications, primarily Excel and Word.
Excellent communication and interpersonal skills.
Ability to read and interpret documents such as safety rules, operating and maintenance instructions, and procedure manuals.
Ability to write routine reports and correspondence.
Ability to speak effectively before groups and customers or employees of the organization.
Ability to add, subtract, multiply, and divide in all units of measure, using whole numbers, common fractions, and decimals.
Ability to compute rate, ratio, and percent and to draw and interpret bar graphs.
Ability to solve practical problems and deal with a variety of concrete variables in situations where only limited standardization exists.
Ability to interpret a variety of instructions furnished in written, oral, diagram or schedule form.

Nice To Haves

Working knowledge of Medicare, Medicaid, CMS regulations, MSP requirements and C-SNP eligibility requirements preferred.
Previous experience in administrative support, healthcare operations, or insurance processing preferred.

Responsibilities

Process incoming mail, emails, and faxes related to C SNP verification and MSP activities.
Review provider verification forms and document qualifying chronic conditions per CMS guidelines.
Prepare and maintain member and provider correspondence, including letters and faxes.
Track and complete department tasks within required CMS timeframes.
Conduct outbound calls to verify coverage and update records timely.
Submit ECRS terminations and eligibility updates according to CMS and internal procedures.
Ensure all documentation is accurate, complete, and audit ready.
Research and resolve eligibility discrepancies.
Maintain daily Coordination of Benefits (COB) and other related files.
Follow up on outstanding items to ensure timely resolution.
Collaborate with internal teams to support efficient workflows.
Maintain regular and consistent attendance.
Perform other duties as assigned