Eligibility Coordinator - Health Plan Operations

About This RoleStep into a role where your work truly makes a difference. As our Health Plan Eligibility Coordinator, you’ll be at the heart of our mission to transform how older adults experience care. Reporting to the Director of Health Plan Operations, you’ll support the daily functions of our health plan operations: managing crucial tasks like Medicaid/Medi-Cal and Medicare eligibility, enrollment and disenrollment tracking, and other key insurance-related activities.
You’ll play a vital part in shaping the systems and processes that keep our operations running smoothly and compliantly, ensuring that every participant can access the care they deserve. In this dynamic, integrated care delivery startup environment, you’ll collaborate across departments, build strong connections, and contribute to the foundation that allows us to scale responsibly.
Most importantly, you’ll join a passionate team committed to redefining what it means to age with dignity, support, and independence—helping older adults thrive in the homes and communities they love.

What Does Success Look Like In This Role:

• Champion Enrollment Success – Develop and manage seamless processes for participant Medicaid/Medi-Cal and Medicare enrollment, ensuring they maintain access to vital benefits.
• Keep Workflows on Track – Maintain accurate, real-time tracking for all eligibility and enrollment workflows across Medicare and Medi-Cal.
• Be a Pre-Enrollment Pro – Partner with LA County, IHSS, and Social Security to confirm all participant data is up-to-date, synced, and ready for enrollment.
• Own Part D Operations – Manage Part D enrollment and eligibility within Centers for Medicare & Medicaid Services systems (MARx, eRPT, COB, Transaction Facilitators), lead audits, and oversee retroactive eligibility processing.
• Drive Redetermination Efforts – Oversee California Department of Health Care Services (DHCS) redetermination data and collaborate with Social Workers to support timely renewals.
• Solve Complex Eligibility Issues – Lead troubleshooting for Part D plan operations including TROOP, PDE, and RAPS rejections.
• Deliver Personalized Support – Provide one-on-one assistance to PACE participants with warmth, care, and exceptional service.
• Guide Medicare Age-Ins – Support participants as they transition into Medicare, making the process smooth and stress-free.
• Track and Monitor with Precision – Oversee self-pay billing activities in partnership with Finance and TPA teams.
• Master the Data Game – Manage monthly enrollment reconciliations, capitation files, and vendor rosters to keep our systems aligned and accurate.
• Support Seamless Transitions – Assist enrollment and disenrollment teams with DHCS submissions, tracking, and compliance activities.
• Ensure Timely Authorizations – Monitor internal authorization workflows, ensure prompt prior authorizations, and conduct retro-reviews of unauthorized services.
• Be Audit-Ready Always – Document and support audit activities to maintain stellar health plan oversight.
• Oversee Participant Materials – Coordinate ID card requests and ensure ADA-compliant materials are delivered on time.
• Stay on Top of Regulations – Manage ongoing Part D regulatory reporting requirements with diligence and attention to detail.
• Wear Many Hats – Step in with all other duties as needed to help our mission thrive!

What Does An Ideal Candidate Look Like?

• Educational Foundation – High school diploma or equivalent required.
• Heart for the Mission – A true passion for serving high-risk seniors and frail older adults.
• Local Know-How – Familiarity with Los Angeles County health coverage, services, and Los Angeles County Department of Public Social Services operations related to Medi-Cal eligibility.
• Part D Expertise – Strong knowledge of Medicare Part D enrollment processes through Centers for Medicare & Medicaid Services applications (MARx, eRPT, COB, Transaction Facilitators).
• Operational Insight – Solid understanding of health plan and provider operations and regulatory requirements (especially in PACE, Medicare Advantage, Medi-Cal, or Medi-Medi settings).
• Proven Experience – 3+ years in eligibility coordination, enrollment, or benefits management (PACE, Medi-Cal, Medicare Advantage, or Dual-Eligible experience strongly preferred).
• Adaptability – Ability to thrive in an evolving, fast-paced environment.
• Tech Savvy – Proficiency in Microsoft Excel preferred.

The Fine Print

• Where You’ll Be – You’ll support our teams across our Los Angeles and Compton locations.
• How You’ll Work – This is a hybrid role, with up to 40% travel based on business needs.
• When You’ll Work – Monday through Friday, 8:00 AM to 5:00 PM.

Your Workstyle In Action

• On-the-Go & Onsite – You’ll split your time between our offices, partner sites, and occasional field visits, supporting teams and participants where they are.
• Independent & Resourceful – You’ll thrive working independently with limited supervision, staying organized and self-motivated while managing multiple priorities.
• Active & Engaged – This role involves extended periods of sitting for computer work, along with walking, standing, and light lifting (up to 20 lbs) when handling materials or equipment.
• Tech-Ready & Connected – Comfort using laptops, cell phones, teleconferencing platforms, and other digital tools to stay connected and responsive in a mobile, fast-paced environment.
• Driving Required – A valid California driver’s license, reliable transportation, and proof of insurance are required for travel between sites.

Join the Movement to Redefine AgingIf you’re ready to use your expertise to make a lasting difference, we’d love to welcome you to our mission-driven team. Here, your work won’t just be about processes and paperwork—it will be about empowering older adults to live healthier, fuller lives in the place they call home.
Bring your passion, your curiosity, and your commitment to excellence—and help us reimagine what aging can look like. Together, we can create something extraordinary.