Medicare Data Coordinator

Verda Healthcare; Huntington Beach (CA); On-site; USD 29,000 - 34,000; Full time

Benefits offered by this job

401(k)

Paid time off

Health insurance

Dental Insurance

Vision insurance

Life insurance

Job summary

Verda Healthcare, Inc. is seeking a Medicare Data Coordinator to support accurate administration of Medicare programs by managing, validating, and analyzing eligibility, enrollment, and claims data.

The role collaborates with internal teams and external vendors to resolve discrepancies and identify trends that indicate errors, fraud, or waste. The position focuses on Part C and Part D data, provider data management, and related Medicare functions, requiring a strong analytical mindset and

Qualifications

• Bachelor’s degree in business, health administration, information technology, or a related field, or equivalent work experience.
• Experience with large health plan data including eligibility, enrollment, claims or provider data is preferred.
• Knowledge of data governance, data quality, and validation best practices.
• Ability to translate business questions into data requirements, queries, and reports.

Responsibilities

• Maintain, review, and validate Medicare eligibility, enrollment, and claims data for accuracy and completeness.
• Coordinate with Provider Data Management on changes from providers or vendors.
• Review contracts and program documentation to determine coverage requirements and billing implications.
• Work with Finance/Claims to troubleshoot and resolve data discrepancies.
• Prepare recurring and ad hoc reports on utilization, cost, and program performance.
• Serve as a resource for colleagues on Medicare data and processes.
• Collaborate with Leadership to align with CMS and organizational standards.
• Support cost containment by identifying unusual spending or utilization patterns.

Skills

SQL

Power BI

Tableau

Excel

Python

R

Data governance

Analytical skills

Education

Bachelor’s degree or equivalent

Tools

SQL Server

Snowflake

Oracle

ETL tools

Job description

Description

Verda Healthcare, Inc. is a Medicare Advantage Prescriptions Drug Plan (MAPD) organization committed to the idea that healthcare should be easily and equitably accessed by all, currently available in Texas and Arizona. Our mission is to ensure that underserved communities have access to health and wellness services, and receive the support needed to live a healthy life that is free of worry and full of joy. We are looking for a Medicare Data Coordinator to join our growing company with many internal opportunities.

Are you ready to join a company that is changing the face of health care across the nation? Verda Healthcare is looking for people like you who value excellence, integrity, caring, and innovation. As an employee, you will join a team dedicated to improving the lives of our Medicare members. Our vision incorporates value-based health care that works. We value diversity and are committed to creating an inclusive workplace where everyone is respected and has the opportunity to succeed.

Align your career goals with Verda Healthcare and we will support you every step of the way.

Position Overview

The Medicare Data Coordinator will support the accurate administration of Medicare-related programs and benefits by managing, validating, and analyzing eligibility, provider, claims, and utilization data. The role helps ensure regulatory compliance, supports accurate payment and reporting, and serves as a resource for colleagues on Medicare data and processes. The Specialist coordinates with internal teams and external vendors to resolve data discrepancies, reconcile invoices against member eligibility and claims data, and identify trends or irregularities that may indicate errors, overpayment, or fraud, waste, and abuse. Areas of support may include Part C Risk and Part D programs, Provider Data Management, and other Medicare-related functions at Verda Healthcare, Inc.

Responsibilities

• Maintain, review, and validate Medicare eligibility, enrollment, and claims data for accuracy and completeness
• Coordinate with Provider Data Management on incoming changes from provider groups or vendors (Adds, Deletes, Changes)
• Review contracts, agreements, and program documentation to determine coverage requirements and billing implications
• Work with the Finance/Claims teams to troubleshoot and resolve billing and data discrepancies
• Prepare recurring and ad hoc reports on utilization, cost, and program performance
• Serve as a resource for colleagues on Medicare enrollment, Provider, Part D and Part C Claims data
• Provide communication and team coordination with follow-up information and clarification on data findings
• Collaborate with Leadership and teammates to support alignment with CMS and organizational standards
• Support cost containment efforts by identifying unusual spending or utilization patterns, including potential fraud, waste, or abuse
• Contribute to the development of training materials, process documentation, and other resources for Verda staff
• May support annual bid preparation and other planning activities by providing data and updating analyses as needed

Technical Skills

• Advanced proficiency in SQL (e.g., complex joins, CTEs, subqueries, window functions) for querying and analyzing large relational databases
• Hands-on experience building dashboards and reports in Power BI, Tableau, or similar business intelligence tools
• Experience with healthcare database systems or data warehouses (e.g., SQL Server, Snowflake, Oracle) is a plus
• Proficiency in Excel, including pivot tables, lookups, and data modeling
• Proficiency in Microsoft Office Suite products (Word, OneDrive, OneNote, etc.)
• Experience with Python or R, ETL tools, or process automation is a plus

Professional Competencies

• Collaborative approach when working with vendors and internal team members
• Strong attention to detail, with solid analytical and problem‑solving skills
• Effective verbal and written communication skills
• Understanding of Medicare programs and benefits and the impact of data accuracy on members and payments
• Ability to manage multiple priorities, work independently on moderately complex assignments, and evaluate results with minimal supervision

Verda Healthcare cares deeply about the future, growth, and well‑being of its employees. Join our team today!

Job Type

Full-time

Location

Huntington Beach, CA

Compensation Range

$21-25/hr

Benefits

• 401(k)
• Paid time off (vacation, holiday, sick leave)
• Health insurance
• Dental Insurance
• Vision insurance
• Life insurance

Schedule

• Full-time onsite (100% in‑office)
• Hours of operations: 9am – 6pm
• Standard business hours Monday to Friday/weekends as needed
• Occasional travel may be required for meetings and training sessions.

Ability To Commute/relocate

• Reliably commute or planning to relocate before starting work (Required)

PHYSICAL DEMANDS

Regularly sit/walk at a workstation in an office or cubicle setting. Must occasionally lift and/or move up to 25-50 pounds.

• Other duties may be assigned in support of departmental goals.

Requirements

• Bachelor’s degree in business, health administration, information technology, or a related field, or equivalent work experience
• Prior experience at a health plan, MSO, or other healthcare organization preferred
• Knowledge Base:
• Experience working with large datasets, preferably including eligibility, enrollment, claims, or provider data
• Understanding of data governance, data quality, and validation best practices
• Experience translating business questions into data requirements, queries, and reports