Eligibility Coordinator - SCAN Temp

Founded in 1977 as the Senior Care Action Network, SCAN began with a simple but radical idea: that older adults deserve to stay healthy and independent. Today, SCAN is a nonprofit health organization serving more than 500,000 people across Arizona, California, Nevada, New Mexico, Texas, and Washington, with over $8 billion in annual revenue. With nearly five decades of experience, we have built a distinctive, values-driven platform dedicated to improving care for older adults through Medicare Advantage, fully integrated care models, primary care, and next-generation care delivery.

About the role

The Eligibility Coordinator - SCAN Temp will maintain SCAN Health Plan's core eligibility system by reconciling, entering, correcting, and deleting member information.

Responsibilities

• Process member applications by reviewing data for deficiencies; assigning codes to data; establishing data entry priorities, and resolving discrepancies by using departmental policies and procedures.
• Research eligibility rejected transactions by identifying discrepancies and report findings to the appropriate business area.
• Enter member data by inputting alphabetic and numeric information into IKA system according to screen format including benefit assignment, group affiliation, provider selection, billing information, revenue codes, and appropriate cross references.
• Ensure regulatory compliance by following departmental desktops, policies and procedures, and adhering to state and Federal regulations and requirements.
• Verify eligibility for enrollment using state and Federal websites.
• Assist co-workers by training, updating processes, and assisting with job duties.
• Provide excellent customer service by making a high volume of outbound calls to members to clarify, obtain, or confirm information needed to successfully complete a member’s enrollment request.
• Represent the department by attending meetings, trainings, and process improvement teams.
• Interpret and explain eligibility and CMS regulations and requirements in person, via email, or telephonically.
• Complete requests received through Enterprise, Department Inbox, and Department Queue by responding appropriately and in a timely fashion to internal and external customers; answering telephonic and written inquiries concerning eligibility issues; following department policies and procedures; and professionally representing the department.
• Maintain professional and technical knowledge by utilizing access to SCAN University online trainings, attending educational workshops, reviewing professional publications, establishing personal networks, and participating in professional societies.
• Prepare eligibility report mailings by generating, reviewing, and distributing eligibility information to providers within defined timelines.
• Contribute to team effort by accomplishing related results as needed.
• Prepare member correspondence by creating, triggering, printing, reviewing, and mailing.
• Assure accurate data from regulatory system reply by utilizing Federal systems and other departmental systems to run reports and collect and analyze data for any necessary updates.
• Perform daily reconciliations to resolve member eligibility issues by analyzing, correcting, or updating data received on daily claims error report, unassigned PCP list, and Incomplete Queue.
• Reconcile discrepancies between member data and various systems.
• Actively support the achievement of SCAN’s Vision and Goals.
• Other duties as assigned.

Requirements

• High School Diploma or equivalent experience required.
• 0-3 years of related experience.
• Performs work under minimal supervision.
• Handles complex issues and problems, and refers only the most complex issues to higher-level staff.
• Possesses comprehensive knowledge of subject matter.
• Provides leadership, coaching, and/or mentoring to a subordinate group. May act as a lead or first-level supervisor.
• Basic technical skills for functional area.
• MS Office - Word, Excel, Outlook, Teams, PowerPoint experience required.
• Basic problem-solving skills.
• Good verbal and written communication and interpersonal skills.

Benefits

• Medical Benefits
• Paid Sick Time
• Excellent 401(k) Retirement Saving Plan
• Robust employee recognition program

Pay

Base Pay Range: $17.00 to $21.00 per hour

Schedule

This is a temporary opportunity for a limited period of time.

Work Mode: Mostly Remote