Coordinator II - Eligibility Consultant – Paper Ops

Job Title: Coordinator II - Eligibility Consultant Paper Ops (Fully Remote)

Candidates can be located anywhere in the US, but pref. EST and CST.

Work Location: Fully remote (US-based)

Schedule: MondayFriday, 8:00 AM4:30 PM EST
Must work EST hours (preference given to EST-aligned candidates)

Safety Sensitive: Yes
Hiring Process: Hiring Managers have hired directly off resumes in the past, subject to change

Remote Work Requirements
Private, dedicated workspace: Required
Screenshot of internet speed: Required at submission

Role Overview
The Eligibility Consultant Paper Ops will support enrollment and eligibility operations across multiple health plans. The role is highly manual, accuracy\'driven, and requires experience with healthcare eligibility, enrollment updates, and regulatory compliance.

Key responsibilities include:
Verifying and updating member enrollment and eligibility information
Manual eligibility and enrollment updates (including urgent and fall\'out items)
Researching and resolving enrollment discrepancies and claim\'related eligibility issues
Maintaining data integrity to prevent downstream claim and billing impacts
Partnering with internal teams to support accurate and timely enrollment processing

Top 3 Skills:
1. Eligibility & Enrollment Processing Expertise
Verifying enrollment status
Updating demographics, effective/term dates, newborns, and terminations
Knowledge of Medicaid, Medicare, MCOs, and enrollment rules
Applying regulatory and legislative requirements correctly

2. Attention to Detail & Data Accuracy
Manual system updates (QNXT or similar systems preferred)
Correcting fall\'out edits and reconciliation discrepancies
Reviewing finance and enrollment reports
Preventing downstream claim and billing errors

3. Analytical & Problem\'Solving Skills
Researching eligibility and claim inquiries (e.g., H03s)
Analyzing reports to identify data issues
Determining the correct fix, not just applying changes
Understanding downstream impacts to other teams and systems

Top\'of\'Resume Candidate Screening Questions (Candidates must include these answered at the top of their resume)
1. Do you have experience verifying member enrollment or updating eligibility information (demographics, dates, plan changes)
2. Have you worked with manual enrollment updates or corrections in a healthcare system (ex: QNXT or similar)
3. Do you have experience researching and resolving eligibility or enrollment discrepancies using reports or reconciliation files
4. Have you handled enrollment requests or urgent updates received via email from health plans or state agencies
5. Do you have experience working claim\'related inquiries tied to eligibility issues (ex: H03s or similar)
6. Are you familiar with Medicaid, Medicare, or Managed Care Organizations (MCOs)
7. Have you performed high\'volume manual data entry where attention to detail and accuracy were critical
8. Do you have strong experience researching data issues and determining appropriate corrections independently
9. Are you comfortable learning and working across multiple systems and using Excel for tracking or analysis
10. Are you able to adapt to changing priorities and understand how your work impacts downstream teams and processes

Position Summary:
The Contractual Eligibility Consultant is responsible to research and validate enrollment information, process enrollment transactions, make outbound calls to enrollees and members to obtain required enrollment information, handle member inquires and participate in enrollment projects. The Contractual Eligibility Consultant will support training initiatives and work to resolve member inquires or concerns. This position is temporary starting around August 31st, working the hours between 8am 8pm. There can be a change in shift to include hours and days, within two-day notice. If inventory is high at the end of the contract December 31st there will be a possibility that the contract can be extended.
What you will do
Handles physical documents and paper records to verify the eligibility of patients or members for healthcare services.
Reviews paper forms, applications, or supporting documentation to gather and validate information such as insurance coverage, demographic data, and eligibility criteria.
Organizes paper-based eligibility documents by creating and maintaining filing systems, ensuring proper document storage, and implementing strategies to improve accessibility and retrieval of information.
Analyzes the paper-based information and documentation to determine the eligibility of patients or members for healthcare services.
Performs manual data entry tasks to input eligibility information into relevant systems or databases.
Ensures compliance with relevant healthcare regulations, policies, and industry standards in relation to paper-based eligibility operations to maintain patient confidentiality.
Identifies opportunities to enhance the efficiency and accuracy of paper-based eligibility operations.
Follows regular, timely feedback as well as the formal performance review process to ensure delivery of exceptional services and engagement, motivation, and personal development.
Generates reports and analyzes data related to paper-based eligibility operations to help improve processes, address bottlenecks, and support decision-making.

Required Qualifications:
Customer Service experience.
Attention to detail and accuracy.
Problem solving skills.
Strong organization skills.
Understands the impact of work to other teams and downstream support areas.
Ability to analyze and research data to make appropriate corrections as necessary.
Strong verbal and written communication skills.
Workplace flexibility - ability to adapt to change

Preferred Qualifications:
Knowledge of Health Care and/or MCOs.
Knowledge of Enrollment.
Knowledge Medicaid and/or Medicare.
Knowledge and comfortability with learning different systems and using Excel

Duties
Verifying and updating member enrollment and eligibility information
Manual eligibility and enrollment updates (including urgent and fall\'out items)
Researching and resolving enrollment discrepancies and claim\'related eligibility issues
Maintaining data integrity to prevent downstream claim and billing impacts
Partnering with internal teams to support accurate and timely enrollment processing

Experience
At least 1 years of overall related experience of Center for Medicare/Medicaid Services (CMS) guidelines for Medicare Part D enrollment processes or previous work experience in regulatory environment Dependable/Responsible/Accountable Excellent spoken and written communication skills Capable of managing through transition, while fostering a positive team environment Confident in decision making ability within strict timelines Exceptional prioritization and organizational skills Acts with integrity and uses sound judgment in dealing with confidential information

Position Summary
The Enrollment Coordinators play a critical role in working with our new member clients to determine eligibility and perform various enrollment activities. Enrollment Coordinators interface with both individual plan members and employer group and requires a strong focus around accurate and timely customer support to ensure client enrollment and retention. The Enrollment Coordinator II reports directly to the Enrollment Supervisor.

Education
Verifiable High School diploma or GED required; Bachelors Degree in Marketing preferred

What days & hours will the person work in this position List training hours, if different.
Mon-Fri 8:00am-4:30pm EST subject to change