Temporary Eligibility Coordinator

Guidehealth•Atlanta, IL

2d•Remote

About The Position

The Eligibility Coordinator plays a critical role in ensuring accurate, timely, and compliant eligibility processing across Guidehealth’s operations. This role manages eligibility updates, monthly file loads, member inquiries, audits, and documentation, ensuring high‑quality data integrity that supports claims accuracy, performance outcomes, and member experience. As a key contributor within the Eligibility Department, you will work cross‑functionally with internal departments, external Home Plans, and auditing teams to maintain compliance with state and federal requirements while upholding the highest accuracy standards. This is a high‑volume, detail‑driven role requiring strong analytical skills, precision, and a commitment to continuous improvement.

Requirements

2–3 years of experience in healthcare or managed care eligibility, including Coordination of Benefits knowledge.
Advanced proficiency in Microsoft Word, Excel, Outlook, and Access.
Ability to analyze data, identify trends, and maintain high accuracy standards.
Strong organizational, problem‑solving, and multitasking abilities.
Ability to work independently and collaboratively in a fast‑paced environment.
Strong written and verbal communication skills.
Knowledge of federal, state, and local eligibility and compliance requirements.

Nice To Haves

Prior experience in Managed Care Eligibility and Coordination of Benefits.

Responsibilities

Eligibility Processing & Documentation Process and maintain returned eligibility forms and documents daily.
Complete member eligibility updates based on Home Plan downloads and client plan documents.
Generate member notification letters and manage website inquiries and urgent eligibility requests.
Auditing, Reporting & Compliance Conduct daily, weekly, and monthly audit activities to ensure data accuracy and compliance standards.
Research and clarify eligibility discrepancies with Home Plan partners.
Track and identify data trends for operational improvements.
Support automation and reporting improvements with the Eligibility Compliance Lead.
Cross‑Functional Coordination Collaborate with Claims, Auditing & System Compliance Operations, and internal departments on eligibility‑related issues.
Maintain group files and coordinate benefit plan updates and additions.
Support PCP auto‑assignment workflows using Access reports and geographic data.
Exchange / APTC Eligibility Support Assist in maintaining eligibility accuracy for Exchange product members, including APTC status and grace‑period tracking.
OPX File Management Download OPX files weekly, update corresponding member records, and communicate OPX status changes to Claims.
Other Duties Perform additional responsibilities as assigned.

Benefits

Work from Home: Guidehealth is a fully remote company, providing you the flexibility to spend less time commuting and more time focusing on your professional goals and personal needs.
Keep Health a Priority: We offer comprehensive Medical, Dental, and Vision plans to keep you covered.
Plan for the Future: Our 401(k) plan includes a 3% employer match to your 6% contribution.
Have Peace of Mind: We provide Life and Disability insurance for those "just in case" moments. Additionally, we offer voluntary Life options to keep you and your loved ones protected.
Feel Supported When You Need It Most: Our Employee Assistance Program (EAP) is here to help you through tough times.
Take Time for Yourself: We offer paid time off plans helping you achieve work-life balance and meet your personal goals.
Support Your New Family: Welcoming a new family member takes time and commitment. Guidehealth offers paid parental leave to give you the time you need.
Learn and Grow: Your professional growth is important to us. Guidehealth offers various resources dedicated to your learning and development to advance your career with us.

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