Eligibility & Enrollment Specialist
Location: Fully Remote, must reside in NYS
Pay Rate: $23.00–$24.00/hour
Employment Type: Contract 6-12 months
We are partnering with a mission-driven healthcare organization seeking an Eligibility & Enrollment Specialist to support Medicaid members, providers, managed care organizations, and community partners throughout the eligibility and authorization process. This fully remote opportunity is ideal for someone who thrives in a fast-paced, detail-oriented environment and enjoys helping individuals access important healthcare and social support services.
Key Responsibilities
- Serve as a primary point of contact for eligibility, enrollment, and prior authorization inquiries via phone and email
- Verify member eligibility and enrollment through state systems such as MEVS and ePACES
- Review records, reconcile data discrepancies, and maintain accurate documentation
- Coordinate with internal departments, providers, managed care plans, and external stakeholders to resolve issues and facilitate access to care
- Support prior authorization processes and eligibility determinations based on established guidelines
- Monitor enrollment data and identify members needing outreach or reassignment
- Assist with compliance-related documentation, appeals, and service reconsiderations
- Meet productivity, quality, and service-level expectations in a high-volume environment
Qualifications
- Experience in eligibility, enrollment, benefits administration, case management, healthcare operations, or related fields
- Medicaid, managed care, or social services experience strongly preferred
- Strong customer service and communication skills
- Ability to interpret policies, procedures, and eligibility guidelines
- Excellent critical thinking and problem-solving abilities
- High attention to detail with strong documentation and data entry skills
- Ability to manage multiple priorities in a remote setting
- Proficiency with Microsoft Office and virtual communication tools (Teams/Zoom)
Ideal Backgrounds
- Medicaid eligibility specialist
- Benefits coordinator
- Managed care representative
- Healthcare customer service professional
- Case management support professional
- Social services program administrator
Why Consider This Opportunity?
- Fully remote flexibility
- Meaningful work supporting access to healthcare and social care services
- Stable contract opportunity with a respected organization
- Collaborative and mission-focused team environment
Nesco Resource offers a comprehensive benefits package for our associates, which includes a MEC (Minimum Essential Coverage) plan that encompasses Medical, Vision, Dental, 401K, and EAP (Employee Assistance Program) services.
Nesco Resource provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state, or local laws.