Eligibility and Provider Coordinator

Eligibility Provider Coordinator

The Eligibility Provider Coordinator supports accurate setup, maintenance, and ongoing updates of provider and member eligibility data across internal systems. This position focuses on high-volume data entry, file processing, and routine data reviews to ensure information is complete, compliant, and up to date. The coordinator assists the Provider Analyst with provider configuration tasks, fee schedule updates and research. The role also supports daily eligibility operations by processing member updates, auditing data, and resolving issues to maintain data integrity and timely workflows.

Minimum & Preferred Qualifications:

Education/Training

Minimum: High school diploma or equivalent

Preferred: Associate's degree or college coursework in Healthcare Administration, Business, or related field.

Experience

Minimum: At least three years of experience in managed care eligibility, provider, or healthcare administrative operations.

Preferred: Experience in managed care, MSO, IPA, or health plan environment; familiarity with member eligibility, eligibility files and providers (e.g., EZ-Cap)

Any combination of educational and work experience that would be equivalent to the stated minimum requirements would qualify for consideration of this position.

Skills, Knowledge & Abilities

Knowledge of provider data structures and healthcare provider information requirements.

Working knowledge of managed care operations, provider networks, credentialing processes, and basic claims concepts.

Knowledge of healthcare eligibility and enrollment processes within managed care, health plan, or insurance environments.

Understanding of member data elements, including demographics, plan assignments, PCP selections, enrollment effective dates, rosters, and 834 eligibility files.

Proficiency with EZ-CAP or similar managed care or claims administration systems, with the ability to quickly learn new systems, tools, and technologies.

Knowledge of HIPAA privacy requirements and appropriate handling of confidential provider and member information.

Strong data entry skills with a high degree of accuracy and attention to detail in high-volume environments.

Ability to validate and compare data across systems and identify missing, inconsistent, or inaccurate information.

Ability to perform routine audits, reconciliations, and quality assurance reviews to maintain provider and eligibility data integrity.

Ability to maintain accurate and organized system configuration records and supporting documentation.

Strong critical-thinking and problem-solving skills, with the ability to research and resolve routine provider and eligibility data discrepancies using established procedures.

Effective written and verbal communication skills with the ability to interact professionally and maintain confidentiality.

Strong organizational and time-management skills with the ability to manage multiple priorities, deadlines, and documentation requirements.

Ability to consistently follow established procedures, workflows, departmental standards, and regulatory requirements.

Physical, Mental & Environmental Requirements:

The physical demands described here are represented by those that must be met by an employee to successfully perform the essential functions of this job. There will be prolonged periods of sitting, working on a computer, and using a telephone/headset. While performing the duties of this job, the employee will regularly be required to walk, stand, bend, lift and/or move up to 15-20 pounds. Ability to work extended hours during peak periods or audit timelines, as needed. Requires visual acuity to review documents, reports, and system data. Specific vision abilities required by this job include close, distance, color, peripheral vision, depth perception and the ability to adjust focus. The physical, mental, and environmental demands described here are representative of those required to successfully perform the essential functions of this job.

Pay Range $26.00 - $29.00 / hourly