Eligibility Coordinator

ProCare Rx; Gainesville (GA); On-site; USD 45,000 - 65,000; Full time

Job summary

ProCare Rx seeks a detail‑oriented Eligibility Coordinator to manage member eligibility input for new groups and assist with client implementations. You will enroll Portal users, process member enrollments and terminations, and coordinate with client contacts to ensure data accuracy on a daily basis.

Role requires strong communication skills, proficiency with Windows PCs, and familiarity with health insurance terms.

Qualifications

• High school diploma or equivalent required.
• Post high school or specialized training in medical field desired.

Responsibilities

• Coordinate input of member eligibility for new groups.
• Assist with implementation for new clients and ensure timely information.
• Enroll on-line management (Portal) users and maintain accounts.
• Enroll new members and process terminations.
• Coordinate with client contacts to ensure data accuracy.

Skills

Communication skills

Windows PC skills

Pharmacy terminology knowledge

Health insurance background

Education

High school diploma or equivalent

Post high school or specialized medical training

Job description

PRINCIPLE RESPONSIBILITIES include but are not limited to:

• 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 limited member communications, personal importation, overflow IC phone support, pharmacy network tasks; etc.

SKILLS AND REQUIREMENTS:

• High school diploma or equivalent required.
• Post high school or specialized training in medical field desired.
• 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.
• Health insurance background and knowledge of pharmacy terminology desired.
• 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.

PHYSICAL DEMANDS

Requires sitting, standing, and occasional light lifting