Healthcare Eligibility Specialist: Access & Accuracy

Texas Children's; Bellaire (TX); On-site; USD 42,000 - 66,000; Full time

Job summary

Texas Children's Hospital is seeking an Eligibility Specialist to ensure member eligibility data is accurate and complete by auditing, reconciling, and updating the claims processing system. You will respond to inquiries from internal and external stakeholders.

You will validate data after daily/monthly loads, manually update records from multiple sources, and ensure compliance with state guidelines and Health Plan policies.

Qualifications

• High School Diploma or GED required.
• Bachelor's degree preferred.
• Two years of experience working with an HMO/MCO organization required.

Responsibilities

• Validate and reconcile member eligibility data after daily/monthly loads to match state data.
• Manually update member eligibility data using multiple sources.
• Ensure data processing aligns with Health Plan policies and state guidelines.

Education

High School Diploma or GED

Bachelor's Degree

Job description

Texas Children's Hospital is seeking an Eligibility Specialist to ensure member eligibility data is accurate and complete by auditing, reconciling, and updating the claims processing system. You will respond to inquiries from internal and external stakeholders.

You will validate data after daily/monthly loads, manually update records from multiple sources, and ensure compliance with state guidelines and Health Plan policies.