Enrollment & Eligibility Coordinator

Ontario, CA 91761

Posted: 10/16/2018 Job Category: Admin/Clerical Job Number: 1798571 Pay Rate: $16.41/hour
Enrollment & Eligibility Coordinator
Kinetic Personnel Group is currently recruiting for an Eligibility Coordinator for a Public Health Agency that is in the Ontario area. This Public Health Agency offers an award-winning corporate culture and excellent CalPERS benefits on the full-time employment side. This Public Health Agency manages over 1 million members of Medicare or Medi-CAL.
The Eligibility Coordinator is responsible for performing tasks associated with the day-to-day operations including member eligibility processing, management report maintenance, and data accuracy validation supporting the Eligibility unit.

Job Duties:
  1. Ensure daily completion of core system Primary Care Physician (PCP) changes, eligibility status changes, and member demographic in a timely manner.
  2. Process Member PCP selection files reported through the State s Enrollment contractor (HealthCare Options).
  3. Process the Member Changes Requests reported through CRM on a daily basis by creating the files, maintaining the Report Log, and forwarding the reports to the Eligibility Unit for daily file upload/updates.
  4. Run and process Member Duplicate file in core system.
  5. Update Member eligibility and demographic data in other vendor s system such as Delta Dental and Pharmacy Benefit Management system.
  6. Establish and maintain processing reports on a daily, weekly, and monthly basis.
  7. Process enrollment and eligibility files in other support modules such as Program Affiliations, Multiple Address, and Coordination of Benefits (COB) in core system.
  8. Process return mail and update internal systems
  9. Provide support to the Eligibility Specialist Unit by maintaining member eligibility audit programs throughout the month and during month end processing.
  10. Makes necessary adjustment to work shift to ensure month-end processing is completed accurately and on schedule.

Requirements (must have):
  • Possession of a high school diploma or equivalent.
  • 3 years in a managed care environment in the areas of eligibility and/or data entry
    • Prior Medi-Cal and Medicare experience preferred. Prior experience analyzing data for completeness and accuracy.
  • Must be willing to be pass a background check and drug test per federal and local regulations
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