Verda Healthcare, Inc. is a Medicare Advantage Prescriptions Drug Plan (MAPD) organization committed to the idea that healthcare should be easily and equitably accessed by all, currently available in Texas and Arizona. Our mission is to ensure that underserved communities have access to health and wellness services, and receive the support needed to live a healthy life that is free of worry and full of joy. We are looking for a Medicare Data Coordinator to join our growing company with many internal opportunities.
 

Are you ready to join a company that is changing the face of health care across the nation? Verda Healthcare is looking for people like you who value excellence, integrity, caring, and innovation. As an employee, you will join a team dedicated to improving the lives of our Medicare members. Our vision incorporates value-based health care that works. We value diversity and are committed to creating an inclusive workplace where everyone is respected and has the opportunity to succeed.

Align your career goals with Verda Healthcare and we will support you every step of the way.

Position Overview
The Medicare Data Coordinator will support the accurate administration of Medicare-related programs and benefits by managing, validating, and analyzing eligibility, provider, claims, and utilization data. The role helps ensure regulatory compliance, supports accurate payment and reporting, and serves as a resource for colleagues on Medicare data and processes. The Specialist coordinates with internal teams and external vendors to resolve data discrepancies, reconcile invoices against member eligibility and claims data, and identify trends or irregularities that may indicate errors, overpayment, or fraud, waste, and abuse. Areas of support may include Part C Risk and Part D programs, Provider Data Management, and other Medicare-related functions at Verda Healthcare, Inc.

Responsibilities:

· Maintain, review, and validate Medicare eligibility, enrollment, and claims data for accuracy and completeness

· Coordinate with Provider Data Management on incoming changes from provider groups or vendors (Adds, Deletes, Changes)

· Review contracts, agreements, and program documentation to determine coverage requirements and billing implications

· Work with the Finance/Claims teams to troubleshoot and resolve billing and data discrepancies

· Prepare recurring and ad hoc reports on utilization, cost, and program performance

· Serve as a resource for colleagues on Medicare enrollment, Provider, Part D and Part C Claims data

· Provide communication and team coordination with follow-up information and clarification on data findings

· Collaborate with Leadership and teammates to support alignment with CMS and organizational standards

· Support cost containment efforts by identifying unusual spending or utilization patterns, including potential fraud, waste, or abuse

· Contribute to the development of training materials, process documentation, and other resources for Verda staff

· May support annual bid preparation and other planning activities by providing data and updating analyses as needed

Technical Skills

· Advanced proficiency in SQL (e.g., complex joins, CTEs, subqueries, window functions) for querying and analyzing large relational databases

· Hands-on experience building dashboards and reports in Power BI, Tableau, or similar business intelligence tools

· Experience with healthcare database systems or data warehouses (e.g., SQL Server, Snowflake, Oracle) is a plus

· Proficiency in Excel, including pivot tables, lookups, and data modeling

· Proficiency in Microsoft Office Suite products (Word, OneDrive, OneNote, etc.)

· Experience with Python or R, ETL tools, or process automation is a plus

Professional Competencies

· Collaborative approach when working with vendors and internal team members

· Strong attention to detail, with solid analytical and problem-solving skills

· Effective verbal and written communication skills

· Understanding of Medicare programs and benefits and the impact of data accuracy on members and payments

· Ability to manage multiple priorities, work independently on moderately complex assignments, and evaluate results with minimal supervision

Verda Healthcare cares deeply about the future, growth, and well-being of its employees. Join our team today!

Job Type: Full-time

Location: Huntington Beach, CA

Compensation Range: $21-25/hr

Benefits:

· 401(k)

· Paid time off (vacation, holiday, sick leave)

· Health insurance 

· Dental Insurance

· Vision insurance 

· Life insurance

Schedule:

· Full-time onsite (100% in-office)

· Hours of operations: 9am – 6pm

· Standard business hours Monday to Friday/weekends as needed

· Occasional travel may be required for meetings and training sessions.

Ability to commute/relocate:

· Reliably commute or planning to relocate before starting work (Required)

PHYSICAL DEMANDS

Regularly sit/walk at a workstation in an office or cubicle setting. Must occasionally lift and/or move up to 25-50 pounds.

*Other duties may be assigned in support of departmental goals.

· Bachelor’s degree in business, health administration, information technology, or a related field, or equivalent work experience

· Prior experience at a health plan, MSO, or other healthcare organization preferred

· Knowledge Base:

- Experience working with large datasets, preferably including eligibility, enrollment, claims, or provider data

- Understanding of data governance, data quality, and validation best practices

- Experience translating business questions into data requirements, queries, and reports