Temporary Eligibility Coordinator

Job Description

About the Role

The Eligibility Coordinator plays a critical role in ensuring accurate timely and compliant eligibility processing across Guidehealths operations. This role manages eligibility updates monthly file loads member inquiries audits and documentation ensuring highquality data integrity that supports claims accuracy performance outcomes and member experience.

As a key contributor within the Eligibility Department you will work crossfunctionally with internal departments external Home Plans and auditing teams to maintain compliance with state and federal requirements while upholding the highest accuracy standards. This is a highvolume detaildriven role requiring strong analytical skills precision and a commitment to continuous improvement.

Core Responsibilities

Eligibility Processing & Documentation

• Process and maintain returned eligibility forms and documents daily.
• Complete member eligibility updates based on Home Plan downloads and client plan documents.
• Generate member notification letters and manage website inquiries and urgent eligibility requests.

Auditing Reporting & Compliance

• Conduct daily weekly and monthly audit activities to ensure data accuracy and compliance standards.
• Research and clarify eligibility discrepancies with Home Plan partners.
• Track and identify data trends for operational improvements.
• Support automation and reporting improvements with the Eligibility Compliance Lead.

CrossFunctional Coordination

• Collaborate with Claims Auditing & System Compliance Operations and internal departments on eligibilityrelated issues.
• Maintain group files and coordinate benefit plan updates and additions.
• Support PCP autoassignment workflows using Access reports and geographic data.

Exchange / APTC Eligibility Support

• Assist in maintaining eligibility accuracy for Exchange product members including APTC status and graceperiod tracking.

OPX File Management

• Download OPX files weekly update corresponding member records and communicate OPX status changes to Claims.

Other Duties

• Perform additional responsibilities as assigned.

Qualifications :

Qualifications

Minimum Requirements

• 23 years of experience in healthcare or managed care eligibility including Coordination of Benefits knowledge.
• Advanced proficiency in Microsoft Word Excel Outlook and Access.
• Ability to analyze data identify trends and maintain high accuracy standards.
• Strong organizational problemsolving and multitasking abilities.
• Ability to work independently and collaboratively in a fastpaced environment.
• Strong written and verbal communication skills.
• Knowledge of federal state and local eligibility and compliance requirements.

Preferred Qualifications

• Prior experience in Managed Care Eligibility and Coordination of Benefits.

Additional Information :

This is a 3-month temporary assignment 

ALIVE with Purpose: How We Thrive at Guidehealth 

At Guidehealth our values come to life in everything we do. 

• We are Driven by Accountability grounded in transparency reliability and integrity as we navigate challenges and opportunities alike. 
• Always Growing Always Learning staying curious and continuously improving inspires us to shape a better future for healthcare. 
• With Collaborative Innovation we solve problems creatively making every experience better for our employees and the patients we serve. 
• At Guidehealth Every Voice Matters we believe our collective strength is rooted in the unique perspectives of each team member. 
• And through Empathy in Action we build stronger connections with those who count on us. 
• This is what it means to be ALIVE with purpose. This is how we thrive together at Guidehealth. 

BENEFITS:

While you are hard at work advancing value-based healthcare we are here to ensure YOU have the care you and your family need and the opportunities for growth and development. Our commitments to you include:

• Work from Home: Guidehealth is a fully remote company providing you the flexibility to spend less time commuting and more time focusing on your professional goals and personal needs.
• Keep Health a Priority: We offer comprehensive Medical Dental and Vision plans to keep you covered.
• Plan for the Future: Our 401(k) plan includes a 3% employer match to your 6% contribution.
• Have Peace of Mind: We provide Life and Disability insurance for those just in case moments. Additionally we offer voluntary Life options to keep you and your loved ones protected.
• Feel Supported When You Need It Most: Our Employee Assistance Program (EAP) is here to help you through tough times.
• Take Time for Yourself: We offer paid time off plans helping you achieve work-life balance and meet your personal goals.
• Support Your New Family: Welcoming a new family member takes time and commitment. Guidehealth offers paid parental leave to give you the time you need.
• Learn and Grow: Your professional growth is important to us. Guidehealth offers various resources dedicated to your learning and development to advance your career with us.

All full-time employees of Guidehealth who work 30 hours per week or more are eligible for our comprehensive benefits package. Temporary employees and contractors are not eligible for benefits.

COMPENSATION:

The listed compensation range listed is paid bi-weekly per our standard payroll practices. Final base pay decisions are dependent upon a variety of factors which may include but are not limited to: skill set years of relevant experience education location and licensure/certifications.

OUR COMMITMENT TO EQUAL OPPORTUNITY EMPLOYMENT 

Diversity inclusion and belonging are at the core of Guidehealths values. We are an equal opportunity employer. We enthusiastically accept our responsibility to make employment decisions without regard to race religious creed color age sex sexual orientation and identity national origin citizenship religion marital status familial status physical sensory or medical disability Family and Medical Leave military or veteran status pregnancy childbirth or other related medical conditions or any other classification protected by federal state and local laws and ordinances. Our management is fully dedicated to ensuring the fulfillment of this policy with respect to hiring placement promotion transfer demotion layoff termination recruitment advertising pay and other forms of compensation training and general treatment during employment. 

OUR COMITTMENT TO PROTECTION OF PATIENT AND COMPANY DATA

This position is responsible for following all Security policies and procedures in order to protect all PHI and PII under Guidehealths custodianship as well as Guidehealth Intellectual Properties.  For any security-specific roles the responsibilities would be further defined by the hiring manager. 

As a remote-first organization handling sensitive healthcare data Guidehealth verifies candidate identity at multiple stages of the hiring and onboarding to safeguard patient privacy data security and compliance requirements.

REMOTE WORK TECHNICAL REQUIREMENTS

Guidehealth is a fully remote company. We provide new employees with the necessary equipment to function in their role at no charge to the employee. Employees provide their own internet connection capable of conducting video calls on camera and connecting to various internal and external systems. The required internet speed is a minimum of 100 mbps download 10 mbps upload. Please run a speed test here to confirm your internet connection meets these requirements. 

Remote Work :

Yes

Employment Type :

Full-time