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Eligibility Coordinator
Confirmed live in the last 24 hours
Rockford, IL, USA • Remote
Experience Level
  • Minimum 2-3 years of experience in the healthcare or managed care industry, primarily in the eligibility role with an understanding of Coordination of Benefits rules
  • Advanced proficiency in the Microsoft Office products, especially Microsoft Word, Microsoft Excel & Microsoft Access
  • Successfully function as an Eligibility Specialist
  • Ability to work independently with minimal supervision and as part of a team
  • Ability to meet deadlines and prioritize tasks; collect, correlate and analyze data
  • Must be organized, self-motivated, detail-oriented, disciplined, professional, and a team player
  • Demonstrates the ability to multi-task with minimal supervision and the ability to prioritize appropriately
  • Able to problem solve, exercise initiative and make low to medium level decisions
  • Basic understanding of current federal, state and local healthcare compliance requirements
  • Effective written and oral communication
  • Experience and knowledge with Medicare Advantage strongly encouraged
  • Independently perform OPX and exchange product related tasks
  • Prioritize the monthly Eligibility process based on capitation and claims processing
  • Input and maintain returned eligibility forms and documents on a daily basis
  • Generate member notification letters
  • Track website inquiries and urgent additions from other departments
  • Responsible to work the eligibility appeals forwarded by other departments
  • Responsible to work on a monthly, daily and weekly audit reports
  • Contact Home Plan for clarification of eligibility
  • Build and maintain group files, coordinate benefit plan updates and additions with the Auditing and System Compliance Operations team
  • Assist with maintaining the PCP auto assignment process through Access reporting based on geographical areas and updating the member's eligibility file
  • Assist with downloading on a weekly basis the OPX files from the Home plan and flag the member's eligibility files as indicated, communications to the claims department regarding the OPX status
  • Assist with maintaining members with the exchange product that are under the APTC status and their grace periods
  • Assist with writing and maintain eligibility workflow documents and training material
  • Stay current on federal and state eligibility requirements
  • Work with Eligibility Lead to automate processes and build new reporting
  • Other duties and responsibilities as assigned

201-500 employees

Energy tech company
Company Overview
Arcadia's mission is to stop climate change by breaking the fossil fuel monopoly. Their technology is lighting a cleaner path forward for everyone, from everyday consumers and small businesses to the innovators building the next generation of energy products.
  • Competitive compensation and paid time off
  • Comprehensive medical, dental, vision, and FSA plans
  • Paid parental leave for everyone
  • Remote work opportunities
  • Professional development and ongoing feedback
  • Company stock options and 401(k)
  • Snacks, beverages, and regular lunches in the office
  • On-site gym, new parent, and wellness rooms in DC
  • Commuter benefits and secure bike storage
  • 100% clean energy match for all employees
Company Core Values
  • Build for good
  • Build for all
  • Build with urgency
  • Build for simplicity
  • Build togethere