Advanced Eligibility & Billing Specialist II

Western Growers Health; Irvine (CA); On-site; USD 45,000 - 60,000; Full time

Job summary

Western Growers Health is seeking an Eligibility Specialist II to support enrollment and billing operations, both automated and manual, within WGAT and PCMI accounts. The role handles EDI eligibility groups, provides client-facing support, and researches discrepancies in eligibility and billing while maintaining HIPAA safeguards.

The position emphasizes accurate processing, customer service excellence, and collaboration with internal teams to resolve inquiries and ensure timely payments.

Qualifications

• Experience handling enrollment and billing tasks in a processing environment.
• Ability to resolve billing discrepancies and respond to client inquiries.
• Strong customer service skills with HIPAA compliance awareness.

Responsibilities

• Process all enrollment and billing transactions including EDI as applicable.
• Research and resolve cash application and billing discrepancies; communicate with clients.
• Maintain HIPAA-compliant workstation and data security practices.
• Create and document Standard Operating Procedures (SOPs) and suggest improvements.
• Meet processing cycle times and audit standards to ensure accuracy and compliance.

Skills

Enrollment processing

Billing support

Customer service

HIPAA compliance

Tools

Genesys

HCPS system

Job description

Western Growers Health is seeking an Eligibility Specialist II to support enrollment and billing operations, both automated and manual, within WGAT and PCMI accounts. The role handles EDI eligibility groups, provides client-facing support, and researches discrepancies in eligibility and billing while maintaining HIPAA safeguards.

The position emphasizes accurate processing, customer service excellence, and collaboration with internal teams to resolve inquiries and ensure timely payments.