Healthcare Eligibility & Billing Specialist I

Pinnacle Health Solutions; Irvine (CA); On-site; USD 32,000 - 48,000; Full time

Job summary

Pinnacle Health Solutions is seeking an Eligibility Specialist I to support Child Care Providers United (CCPU) through enrollment and billing on the CCPU Portal and HCPS. You will guide providers on eligibility and reimbursement issues with a focus on accuracy and service excellence.

Your responsibilities include processing enrollment transactions, researching discrepancies, and maintaining HIPAA-compliant data. Strong communication and organizational skills are essential.

Qualifications

• Knowledge of health care eligibility and billing procedures.
• HIPAA and ERISA regulations understanding.
• Strong communication and research abilities.
• Experience with enrollment systems and data entry.

Responsibilities

• Maintain eligibility for CCPU accounts and HCPS as assigned.
• Process enrollment transactions (adds, changes, terminations).
• Provide customer service to providers on enrollment and reimbursement.
• Create and document SOP annually and identify process improvements.
• Maintain HIPAA-compliant workstation and data security.
• Meet processing cycle time and production deadlines.

Skills

Spanish language

Customer service

Excel

Word

Outlook

HIPAA knowledge

Analytical skills

Education

High school diploma

Tools

HCPS system

Job description

Pinnacle Health Solutions is seeking an Eligibility Specialist I to support Child Care Providers United (CCPU) through enrollment and billing on the CCPU Portal and HCPS. You will guide providers on eligibility and reimbursement issues with a focus on accuracy and service excellence.

Your responsibilities include processing enrollment transactions, researching discrepancies, and maintaining HIPAA-compliant data. Strong communication and organizational skills are essential.