Benefits and Eligibility Coordinator

Description:

JOB SUMMARY:

The Benefits & Eligibility Coordinator provides operational support for benefit configuration and eligibility processing within a managed care environment. This position helps maintain the accuracy, integrity, and completeness of member demographic data, benefit structures, and eligibility records to support appropriate claims adjudication, provider reimbursement, and member access to services.

Working under the direction of the Benefits & Eligibility Manager, the Coordinator processes benefit and eligibility updates, works assigned queues, researches data discrepancies, and assists with routine eligibility file validation. This role partners with Claims, IT, Provider Services, and other internal departments to help resolve issues and maintain accurate, up-to-date benefit and member information in the system.

The Benefits & Eligibility Coordinator contributes to accurate, compliant, and efficient benefit and eligibility operations through careful data entry, quality review, timely issue resolution, and adherence to established procedures across assigned product lines.

Requirements:

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 two (2) years of experience in Managed Care Eligibility, Benefits Administration, or healthcare administrative operations.

Preferred: Experience in a managed care, MSO, IPA, or health plan environment; familiarity with member eligibility, eligibility files, benefits, and systems such as 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

• Working knowledge of eligibility processes, benefit configuration, and how these functions may impact claims adjudication and authorizations.
• General understanding of benefit structures including copays, coverage limits, exclusions, and applicable guidelines.
• Familiarity with eligibility file formats, data elements, enrollment processes, and common data-quality issues.
• Ability to review benefit information and accurately enter or update system data according to established procedures.
• Strong attention to detail and ability to identify errors and inconsistencies.
• Effective research, organizational, and problem-solving skills.
• Ability to prioritize assigned tasks and work queues in a fast-paced environment.
• Strong written and verbal communication skills for collaboration with internal departments.
• Ability to follow SOPs, maintain documentation, and adapt to workflow changes.
• Intermediate computer and technical skills, including use of EZ-Cap or equivalent systems.
• Ability to work independently within established guidelines and escalate issues appropriately.
• Commitment to confidentiality and compliance with HIPAA.
• Flexibility to adapt to system changes, workflow updates, and shifting operational priorities.

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