Temporary Eligibility Coordinator

About the Role

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

As a key contributor within the Eligibility Department, you will work cross‑functionally 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 high‑volume, detail‑driven role requiring strong analytical skills, precision, and a commitment to continuous improvement.

• 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.

• 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.

• Collaborate with Claims, Auditing & System Compliance Operations, and internal departments on eligibility‑related issues.
• Maintain group files and coordinate benefit plan updates and additions.
• Support PCP auto‑assignment workflows using Access reports and geographic data.

• Assist in maintaining eligibility accuracy for Exchange product members, including APTC status and grace‑period tracking.

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

• Perform additional responsibilities as assigned.

• 2–3 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, problem‑solving, and multitasking abilities.
• Ability to work independently and collaboratively in a fast‑paced environment.
• Strong written and verbal communication skills.
• Knowledge of federal, state, and local eligibility and compliance requirements.

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

This is a 3-month temporary assignment

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.

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 commitment s 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)…