Eligibility Coordinator

ProCare Rx; Gainesville (GA); On-site; USD 42,000 - 64,000; Full time

Job summary

ProCare Rx is seeking an Eligibility Coordinator to input member eligibility for new groups, support client implementations, and coordinate with client contacts to ensure timely and accurate information. The role includes enrolling online Portal users, handling terminations, and working with multiple departments to align eligibility requirements.

The ideal candidate has strong communication, organizational skills, and experience in healthcare customer service, with proficiency in Windows

Qualifications

• 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 in health care.
• Excellent communication with clients, pharmacies, and plan members.
• Proficient PC skills in Windows-based applications.
• Health insurance background and knowledge of pharmacy terminology desired.
• Flexible with changing department needs.
• Highly organized with strong attention to detail.
• Flexible with scheduled work hours.

Responsibilities

• Coordinate input of member eligibility for all new groups.
• Assist with implementation for new clients.
• Coordinate with client contacts for accurate and timely information.
• Enroll online Portal users and maintain accounts.
• Enroll new members or process terminations.
• Work with multiple departments to coordinate eligibility requirements.
• Review daily reporting for eligibility corrections.
• Answer calls related to eligibility needs.
• Update eligibility systems daily and ensure data integration.
• Maintain eligibility files for medical coverage recipients (PHI).
• Handle escalated eligibility issues to resolve problems.
• Maintain correspondence and eligibility files.
• Perform scheduled reviews and QA for member eligibility.
• Assist with go-lives and testing data files.
• Additional duties including member communications, importation, overflow IC phone support, pharmacy network tasks.

Skills

Customer service

Communication skills

Attention to detail

Organization

Flexibility

Education

High school diploma or equivalent

Post high school training in medical field

Tools

Windows-based applications

Job description

Description

• 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.

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