Eligibility Coordinator at LSMA Management Inc – san bernardino, California

JOB SUMMARY

The Eligibility Coordinator is responsible for the accurate, timely processing and maintenance of member eligibility data. This position supports daily eligibility operations – including file processing, data validation, member record updates, discrepancy resolution, and routine audits – to ensure data integrity and compliance with internal standards. The role provides essential operational support to internal departments that rely on precise eligibility information.

MINIMUM & PREFERRED QUALIFICATIONS

Education/Training

Minimum: High school diploma or equivalent.

Preferred: Associate’s degree or coursework in Healthcare Administration, Business, or related field.

Experience

Minimum: 1+ year of managed care eligibility or healthcare administrative experience.

Preferred: Experience in managed care, MSO, IPA, or health plan environments. Familiarity with eligibility systems and file formats (e.g. EX-CAP, rosters, 834 files).

Any combination of educational and work experience that would be equivalent to the stated minimum requirements would qualify for consideration of this position.

Skills, Knowledge & Abilities

· Knowledge of eligibility and enrollment processes in healthcare or managed care.

· Understanding of demographics, plan assignments, PCP selections, and enrollment dates.

· Familiarity with HIPAA privacy requirements.

· Understanding of Medi-Cal, Medicare, and commercial eligibility workflows (preferred).

· Ability to identify discrepancies, missing data, or data-entry errors.

· Strong attention to detail and accuracy in data entry and documentation.

· Proficiency in Excel, Outlook, Word, Teams, and related tools.

· Strong written and verbal communication skills.

· Ability to interpret data across systems and documents.

· Ability to follow established procedures and processing standards.

· Ability to manage competing priorities and deadlines.

· Ability to work effectively within a team environment.

· Ability to learn new systems, workflows, and updates quickly.

· Ability to remain focused during periods of high volume or tight timelines.

PHYSICAL, MENTAL & ENVIRONMENTAL REQUIREMENTS

The physical, mental, and environmental demands described here are representative of those required to successfully perform the essential functions of this job. This position requires the ability to work for extended periods at a computer while performing detailed eligibility review and data entry. The role involves frequent sitting, with occasional walking, standing, bending, and lifting of materials weighing up to 15-20 pounds. Visual acuity is essential for reviewing reports, documents, and system data, including the ability to adjust focus and distinguish detail. The work environment may require sustained concentration, particularly during peak processing periods or audit cycles, and the employee may occasionally need to work extended hours to meet deadlines. The position also demands adherence to confidentiality and the ability to maintain accuracy and productivity in a standard office setting with regular computer and telephone use.