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Responsibilities
Job Title: Eligibility/ Medicare Enrollment Coordinator
Duration: 5 plus month with possible extension
Location: Fully Remote
Pay Range: $19- $21.00/hr
• Work Location: Fully remote (US-based)
• Schedule: Monday–Friday, 9:00 AM–6:30 PM EST
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
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