Eligibility Coordinator

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  • 18-00212
  • Full Time/Contract
  • Recruiting
  • Rancho Cucamonga, CA
Job Description
Our Client is a not-for-profit, rapidly growing Medi-Cal and Medicare health plan serving over 1,138,447 residents of the Riverside and San Bernardino counties. Our client maintains a Positive Team Culture as demonstrated by being voted by Los Angeles News Group readers as "Favorite Overall Company to Work For,” "Favorite Training Program” and "Favorite Workplace Culture” in their 2014 Winning Workplaces survey.

Eligibility Coordinator

Under the guidance of the Eligibility Supervisor, the Eligibility Coordinator performs data entry tasks necessary to add, change, daily and weekly member provider changes and member eligibility and demographic changes in core system. Responsible for accurate and timely input of data for State and Medicare eligibility information. 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.


  • Ensure daily completion of core system PCP changes, eligibility status changes, and member demographic in a timely manner.
  • Process Member PCP selection files reported through the State's Enrolment contractor (HealthCare Options).
  • 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.
  • Run and process Member Duplicate file in core system.
  • Update Member eligibility and demographic data in other vendor's system such as Delta Dental and
  • Pharmacy Benefit Management system.
  • Establish and maintain processing reports on a daily, weekly, and monthly basis.
  • Process enrollment and eligibility files in other support modules such as Program Affiliations, Multiple Address, and Coordination of Benefits (COB) in core system.
  • Process return mail and update internal systems
  • Provide support to the Eligibility Specialist Unit by maintaining member eligibility audit programs throughout the month and during month end processing.
  • Makes necessary adjustment to work shift to ensure month-end processing is completed accurately and on schedule.
  • Support Eligibility Supervisor with the maintenance of Eligibility Management Reports and Policy and Procedures documentation binder.
  • Other duties as required to ensure Health Plan operations are successful.
  • Ensure the privacy and security of PHI (Protected Health Information) as outlined in Company's policies and procedures relating to HIPAA compliance.


  • Possession of a high school diploma or equivalent.
  • Three (3) years experience 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.
  • Familiarity with PC computers running Microsoft Windows; Microsoft Excel, Microsoft Word, and Microsoft Access.
  • KnowledClient of managed care practices including member eligibility, and capitation. Ability to gather and analyze data in a detailed and highly organized manner.
  • Excellent interpersonal/communication skills, problem solving capabilities, ability to establish and maintain effective working relationships, trustworthy, reliable and an independent worker


  • $16.41/hr
  • Temp 6 month contract


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