Eligibility Coordinator

Job Description

Job Description

PRINCIPLE RESPONSIBILITIES include but are not limited to:

• Coordinates the input of member eligibility for all new groups
• Assists with the implementation process for new clients
• Coordinates with client contacts to ensure information is received is accurate and timely
• Enrolls on-line management (Portal) users and maintains accounts
• Enrolls new members and/or processes terminations
• Works with multiple departments to coordinate eligibility requirements
• Utilizes both manual and systematic enrollment process
• Reviews daily reporting for eligibility corrections
• Answers incoming telephone calls related to eligibility needs
• Ensures eligibility systems are updated and data is appropriately integrated on a daily basis
• Maintains the eligibility files for medical coverage recipients (PHI)
• Handles escalated eligibility issues to ensure problems are resolved
• Ensures that all correspondence and eligibility files are properly maintained
• Perform scheduled review and quality assurance for member eligibility
• Assist with go-lives and testing data files
• Performs various related duties as assigned including but not limited member communications, personal importation, overflow IC phone support, pharmacy network tasks; etc.

SKILLS AND REQUIREMENTS:

• High school diploma or equivalent required.
• Post high school or specialized training in medical field desired.
• Minimum three years experience in a customer service position, preferably as an Office Manager or a similar service position in the health care industry.
• Must have excellent communication skills and the ability to work effectively with clients, pharmacies, and plan members, internal and external contacts.    
• Proficient PC skills in Windows-based applications.
• Health insurance background and knowledge of pharmacy terminology desired.
• Ability to be flexible and quickly adapt to changing needs in department.
• Must be highly organized with strong attention to detail.
• Must be flexible with scheduled work hours.

PHYSICAL DEMANDS

Requires sitting, standing, and occasional light lifting