Medicare Eligibility & Compliance Coordinator

Astiva Health; Orange (CA); On-site; USD 55,000 - 75,000; Full time

Benefits offered by this job

401(k)

Dental Insurance

Health Insurance

Life Insurance

Vision Insurance

Paid Time Off

Job summary

Astiva Health in Orange, CA seeks an Eligibility Operations Specialist to maintain member eligibility data, verify C SNP eligibility, and support CMS-compliant processing of MSP activities. This role serves as a liaison across teams and regulatory systems to ensure accuracy and timely actions.

The ideal candidate will have Medicare Advantage experience, strong organizational skills, and proficiency with Microsoft Office, with attention to regulatory deadlines and audit readiness.

Qualifications

• High school diploma or equivalent required.
• Minimum 2+ years’ experience with Medicare Advantage required.
• Working knowledge of Medicare, Medicaid, CMS regulations, MSP requirements and C-SNP eligibility requirements preferred.
• Previous experience in administrative support, healthcare operations, or insurance processing preferred.
• Excellent verbal and written communication skills.
• Strong organizational skills with the ability to manage multiple priorities and regulatory deadlines while maintaining accuracy.
• Demonstrate the ability to work independently and prioritize workload while maintaining accuracy and productivity.
• Proficient in Microsoft Office applications, primarily Excel and Word.

Responsibilities

• Process incoming mail, emails, and faxes related to C SNP verification and MSP activities.
• Review provider verification forms and document qualifying chronic conditions per CMS guidelines.
• Prepare and maintain member and provider correspondence, including letters and faxes.
• Track and complete department tasks within required CMS timeframes.
• Conduct outbound calls to verify coverage and update records timely.
• Submit ECRS terminations and eligibility updates according to CMS and internal procedures.
• Ensure all documentation is accurate, complete, and audit ready.
• Research and resolve eligibility discrepancies.
• Maintain daily Coordination of Benefits (COB) and other related files.
• Follow up on outstanding items to ensure timely resolution.
• Collaborate with internal teams to support efficient workflows.
• Maintain regular and consistent attendance.
• Perform other duties as assigned.

Skills

Medicare knowledge

CMS regulations

MSP requirements

C-SNP eligibility

Verbal & written communication

Organizational skills

Independent work

Microsoft Office (Excel & Word)

Education

High school diploma or equivalent

Tools

Microsoft Office

Job description

Astiva Health in Orange, CA seeks an Eligibility Operations Specialist to maintain member eligibility data, verify C SNP eligibility, and support CMS-compliant processing of MSP activities. This role serves as a liaison across teams and regulatory systems to ensure accuracy and timely actions.

The ideal candidate will have Medicare Advantage experience, strong organizational skills, and proficiency with Microsoft Office, with attention to regulatory deadlines and audit readiness.