Eligibility Specialist/Care Coordinator
$47,840–$62,400 year
On-siteLong Beach, California, United States
Job Summary
Verify and maintain client insurance eligibility and benefits throughout the duration of treatment while monitoring status for compliance with SAPC, DHCS, Drug Medi-Cal, and health plan requirements. Proactively identify at-risk clients to initiate follow-up, assist with renewals and recertifications, and coordinate with county agencies and managed care plans to prevent service interruptions. Obtain authorizations, document all activities in the electronic health record, and educate clients on renewal deadlines and documentation needs. Collaborate with clinical, admissions, and billing staff to ensure programmatic eligibility and resolve issues with Medi-Cal offices. Maintain accurate tracking spreadsheets and reports while adhering to HIPAA confidentiality standards.
Required Qualifications
- High school diploma or equivalent
- Valid California Driver's License (or ability to obtain one)
- current automobile insurance
- Background check
- TB clearance
- Minimum of one (1) year of experience in healthcare eligibility, insurance verification, case management, care coordination, admissions, behavioral health, or a related field
Desired Qualifications
- Associate degree in Healthcare Administration, Human Services, Social Work, Behavioral Health, Business Administration, or a related field
- CPR/First Aid certification
- Experience verifying Medi-Cal, Drug Medi-Cal, commercial insurance, or managed care benefits
- Familiarity with SAPC, DHCS, Drug Medi-Cal Organized Delivery System (DMC-ODS), and health plan eligibility requirements
- Experience working with electronic health record (EHR) systems and insurance verification portals
- Strong organizational, problem-solving, and time management skills with exceptional attention to detail
- Excellent communication and customer service skills with the ability to work effectively with clients, families, insurance representatives, and community agencies
- Ability to manage multiple priorities
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