Eligibility Coordinator

Summary

Under the general direction of the Supervisor, Eligibility Call Center, the Eligibility Coordinator is responsible for answering all incoming phone calls, emails, and reporting for member eligibility verification.

Duties and Responsibilities:

• Answer provider phone calls requesting eligibility verification; document each phone call in EZ-CAP and sPHERICAL.
• Handle all internal and external eligibility email verification requests; documenting emails answered in EZ-CAP and sPHERICAL in detail.
• Verify eligibility in our system against various sources of eligibility including Medi-Cal State website, Health Plan websites, Ability, Availity, Navinet, Health Plan Electronic files, and Passport.
• Update eligibility properly ensuring documentation of all changes.
• Call health plans to verify eligibility if all available resources do not provide the information needed to input or update the member in EZ-CAP.
• Add and/update members, including documentation within 24 hours of receiving the request.
• Run and work eligibility data reports as assigned by Team leadership.
• Respond to emails within 24 to 48 hours of receiving the request and information.
• Update work productivity trackers according to standard operating procedure. 
• Assist the rest of the team to ensure all teamwork is handled timely and in accordance with team policies and procedures.
• Additional responsibilities as assigned.

Minimum Job Requirements:

• High school diploma.
• One-year experience in a customer service role or in a healthcare environment is strongly preferred.
• Strong commitment to detail with ability to work with little supervision.
• Excellent customer service and documentation skills.

Skills and Abilities:

• Microsoft Office Proficiency (Outlook, MS Word, MS Excel).
• Type 30 words per minute or higher.
• Eagerness to contribute to a team-oriented environment. 
• Ability to multi-task in a fast-paced environment. 
• Excellent oral and written communication skills.

Salary Range:

• $19.00 - $26.00 hourly, depending on experience.