Entry-Level Eligibility & Billing Specialist (Child Care)

Pinnacle Claims Management; Irvine (CA); On-site; USD 52,000 - 68,000; Full time

Job summary

Pinnacle Claims Management is seeking an Eligibility Specialist I to support Child Care Providers United (CCPU) via the CCPU Portal and HCPS. You will guide providers on eligibility management and explain reimbursement issues while maintaining HIPAA-compliant processes.

The role emphasizes enrollment accuracy, timely processing, and high-quality customer service. Based in Irvine, CA, the position requires attention to detail and strong communication with internal teams and external providers.

Responsibilities

• Maintain eligibility for CCPU accounts as assigned including clients that submit eligibility electronically.
• Assist in reviewing and processing all manual and/or Electronic Data Interchange (EDI) enrollment transactions in HCPS as received from CCPU, providers, or internal sources in accordance with policies.
• Assist in producing electronic spreadsheets and reports for audit and processing purposes.
• Research and correct account application issues in CCPU Portal and HCPS; determine and correct benefit parameters; contact clients to explain and resolve billing discrepancies; verify refunds for terminations and overpayments.
• Maintain a HIPAA-compliant workstation and utilize security techniques to protect confidential data.
• Meet processing cycle time standards and production due dates set by management.
• Identify inefficiencies within processes and suggest solutions to save time and reduce risk.
• Create and document at least one new SOP annually.
• Identify and implement at least one process improvement annually.
• Support providers by facilitating qualifications on time and for the correct reimbursement amount.
• Provide timely customer service to clients for enrollment and reimbursement inquiries.
• Interface with internal departments and external contacts to coordinate activities and resolve eligibility and billing issues.
• Represent CCPU with professionalism and discretion in all interactions.
• Perform other duties as assigned.

Job description

Pinnacle Claims Management is seeking an Eligibility Specialist I to support Child Care Providers United (CCPU) via the CCPU Portal and HCPS. You will guide providers on eligibility management and explain reimbursement issues while maintaining HIPAA-compliant processes.

The role emphasizes enrollment accuracy, timely processing, and high-quality customer service. Based in Irvine, CA, the position requires attention to detail and strong communication with internal teams and external providers.