Eligibility and Coverage Services Coordinator II

okgov; Oklahoma; On-site; USD 42,000 - 52,000; Full time

Benefits offered by this job

State benefits

Retirement plan

11 paid holidays annually

Vacation & sick leave

Job summary

The Oklahoma Health Care Authority (OHCA) is seeking an Eligibility and Coverage Services Coordinator II to support SoonerCare and other Medicaid programs in Oklahoma City. This full-time role handles member and provider inquiries, enrollment and eligibility verifications, and claims processing to ensure accurate, compliant service.

You will stay current on policy revisions and collaborate with multiple departments to maintain high-quality service, with regular weekday hours and full-state

Qualifications

• 1 year of clerical office or customer service experience plus 2 years in customer service.

Responsibilities

• Research and resolve member inquiries, provider inquiries, and denied claims.
• Investigate access to care issues, fraud, abuse, and quality assurance concerns.
• Interpret and communicate SoonerCare policies and procedures to providers and members.
• Process and resolve enrollment, eligibility verifications, and plan changes.

Skills

Medicaid policies

Member/provider inquiries resolution

Claims processing

Attention to detail

Policy compliance

Education

Clerical office experience

Customer service experience

Job description

Eligibility and Coverage Services Coordinator II

807 HEALTH CARE AUTHORITY

Full/Part-Time

Full time

Job Type: Regular

Compensation: $22.81875/hour

Why You'll Love Working Here

At the Oklahoma Health Care Authority (OHCA), your work matters. Every day, our team helps ensure Oklahomans have access to better health and better care. Guided by our core values, Passion for Purpose, Trust & Transparency, Empowerment & Accountability, Best-in-Class, Outcome-Driven, and Servant Leadership , we foster a workplace where people feel supported, respected, and empowered to make an impact. Learn more about OHCA.

Let's Talk Benefits

• Generous state-paid benefit allowance to offset insurance premiums.
• A wide selection of insurance plans with no pre-existing condition exclusions.
• Flexible Spending Accounts for health care and dependent care.
• Retirement Savings Plan with employer contributions.
• 11 paid holidays annually.
• 15 days of vacation and 15 days of sick leave in the first year.
• Longevity Bonus recognizing years of public service.
• Public Service Loan Forgiveness eligibility and tuition reimbursement.
• Wellness benefits, including an on-site gym and fitness center discounts.

Job Description

Location: 4345 N Lincoln Blvd, Oklahoma City, OK 73105

Salary: $22.81875/hour

Work Schedule: Monday - Friday

Primary Hours: 8:00 a.m. - 5:00 p.m.

Agency/Division Information

The Oklahoma Health Care Authority (OHCA) works to ensure Oklahomans have access to better health and better care. The agency's core values include passion for purpose, trust and transparency, empowerment and accountability, best in class and outcome-driven, and servant leadership. As part of the interview process, candidates may be required to attend an in-person interview at our Oklahoma City office.

Position Purpose

The ECS Coordinator II plays a critical role in supporting the Oklahoma Health Care Authority's mission by ensuring efficient and effective administration of SoonerCare and other Medicaid programs. This position is responsible for resolving member and provider inquiries, processing claims, managing member enrollments, and maintaining compliance with program policies. The role requires strong communication skills, attention to detail, and the ability to navigate complex program guidelines, all while maintaining a high standard of service to internal and external stakeholders.

Essential Functions May Include

• Research and resolve provider and member inquiries, complaints, and denied claims.
• Investigate and address access to care issues, fraud, abuse, and quality assurance complaints.
• Interpret and communicate SoonerCare policies and procedures to providers, members, and stakeholders.
• Educate on program coverage, services, and eligibility guidelines for SoonerCare, BCC, DOC Inpatient, TEFRA, and Insure OK programs.
• Process and resolve electronic claims inquiries and claims reconciliation.
• Manage member applications, enrollments, plan changes, and eligibility verifications.
• Identify and report system discrepancies.
• Research and implement system updates and corrections.
• Stay current on SoonerCare rule revisions and program changes.
• Maintain organized reference materials and update written controls.
• Coordinate with other departments on referral issues and operational procedures.
• Communicate independently with members and stakeholders to resolve issues.
• Participate in special projects, member outreach, and educational efforts.
• Represent OHCA in meetings, seminars, and training forums.
• Support workflow during staff absences and manage high call volumes.
• Other duties as assigned.

Knowledge, Skills, Abilities and Competency Requirements

The ECS Coordinator II requires in-depth knowledge of Medicaid program policies, strong communication skills for resolving inquiries, and the ability to manage complex administrative processes. This role demands attention to detail, effective collaboration, and the ability to navigate both member and provider concerns. The Korn Ferry competencies that align well with this position are Manages Complexity, for handling detailed program and policy administration, and Collaborates, for working effectively with both internal and external stakeholders to resolve issues and ensure program success.

Education and/or Experience

1 year of experience in clerical office work or as a customer services representative plus 2 years of experience in customer ser