Coordinator I, Eligibility

Summary

The Coordinator I, Eligibility, is responsible for answering incoming phone calls and emails requesting eligibility verification. Under the general direction of the Supervisor, Eligibility Call Center, this role requires researching members in internal systems and external sources to ensure accurate eligibility is attained and documented.

Duties and Responsibilities:

• Answer incoming phone calls from providers and office staff requesting eligibility verification.
• Respond to internal and external eligibility verification of email requests within 24 hours of receiving the request. 
• Document all phone calls and email requests for eligibility verifications in internal systems according to standard operating procedures.
• Verify eligibility in internal systems against various sources of eligibility including Medi-Cal State website, Health Plan websites, Availity, Health Plan Electronic files, etc.
• Add and/or update member eligibility records according to research findings within 24 business hours of receiving requests, ensuring proper documentation of all changes.
• Call health plans to verify member eligibility, as needed. 
• Support other Teammates to ensure Team responsibilities are handled timely and in accordance with team policies and procedures.
• Research members identified by the Eligibility EDI Team that are no longer found on EDI files. 
• Consistently maintain adherence to production and accuracy of metrics. 
• Assist with working on reports assigned by team leadership.
• Other duties as assigned by team leadership.

Minimum Job Requirements:

• High school diploma or GED equivalent.
• One-year experience working in a call center environment; health care environment preferred.

Skills and Abilities:

• Minimum or higher proficiency with Microsoft Office programs (Outlook, MS Word, MS Excel).
• Effective oral, written, and interpersonal communication skills.
• Effective commitment to detail.
• Effective customer service and documentation skills.
• Effective data entry and typing skills.
• Commitment to fully understand and adhere to all Team policies and procedures.

Salary Range:

• $20 – $23 hourly, depending on experience