Vice President, Medicaid Eligibility

Vice President, Medicaid Eligibility

The Vice President, Medicaid Eligibility is responsible for overseeing all Medicaid Eligibility operations to ensure patient accounts are processed accurately, efficiently, and in compliance with federal and state Medicaid regulations. This role provides strategic leadership for eligibility teams, ensuring timely completion of Medicaid applications, redeterminations, and supporting documentation while meeting client expectations and maximizing patient access to coverage.

The Vice President, Medicaid Eligibility drives operational excellence through workflow optimization, staff development, performance monitoring, and compliance oversight. This position partners with clients, state agencies, and internal stakeholders to improve eligibility outcomes, reduce uninsured populations, and achieve departmental financial and operational goals.

Duties and Responsibilities

• Attend client meetings and maintain strong relationships with hospital leadership and key stakeholders.
• Serve as a subject matter expert on Medicaid eligibility policies, procedures, and regulatory requirements.
• Monitor eligibility team productivity, quality, and performance metrics to ensure client expectations and departmental goals are achieved.
• Review productivity and eligibility outcome reports with clients and senior leadership.
• Ensure timely and accurate completion and submission of Medicaid applications, renewals, redeterminations, and supporting documentation.
• Review high-priority and complex eligibility cases to ensure timely resolution and maximum coverage outcomes.
• Develop, implement, and continuously improve operational workflows, training programs, key performance indicators (KPIs), and strategic initiatives.
• Establish and maintain standard operating procedures, policies, and quality assurance programs for Medicaid Eligibility operations.
• Effectively manage and develop direct reports while fostering a culture of accountability, compliance, and continuous improvement.
• Partner with state Medicaid agencies and client representatives to resolve escalated eligibility issues and improve operational efficiency.
• Stay current on federal and state Medicaid regulations, policy changes, and eligibility requirements, ensuring organizational compliance.
• Conduct audits and quality reviews to ensure accuracy, consistency, and compliance across all eligibility activities.
• Recommend staffing adjustments and resource allocation based on workload trends, productivity metrics, and business needs.
• Prepare weekly operational and financial reports for senior management review.
• Maintain professional relationships with referral sources, facility associates, and community partners.
• Support business development efforts by participating in industry events, including HFMA and healthcare revenue cycle conferences. Perform other duties as assigned
• Use, protect and disclose patients' protected health information (PHI) only in accordance with Health Insurance Portability and Accountability Act (HIPAA) standards

Qualifications

• Bachelor's degree or equivalent work experience.
• Minimum 10 years of Medicaid Eligibility, healthcare revenue cycle, patient financial services, or healthcare operations experience.
• Demonstrated expertise in Medicaid eligibility determination, application processing, state-specific Medicaid programs, and regulatory compliance.
• Strong understanding of hospital revenue cycle operations and the financial impact of Medicaid eligibility outcomes.
• Experience leading large teams and managing multiple client relationships.
• Proven ability to develop operational processes, performance metrics, and staff training programs.
• Knowledge of medical terminology and healthcare reimbursement methodologies.
• Strong analytical, problem-solving, organizational, and decision-making skills.
• Excellent written, verbal, presentation, and interpersonal communication skills.
• Proficiency with eligibility systems, hospital information systems, and Microsoft Office applications.

Working Conditions

• Physical Demands: While performing the duties of this job, the employee is occasionally required to move around the work area; Sit; perform manual tasks; operate tools and other office equipment such as computer, computer peripherals and telephones; extend arms; kneel; talk and hear.
• Mental Demands: The employee must be able to follow directions, collaborate with others, and handle stress.
• Work Environment: The noise level in the work environment is usually minimal.

Med-Metrix will not discriminate against any employee or applicant for employment because of race, color, religion, sex (including pregnancy, gender identity, and sexual orientation), parental status, national origin, age, disability, genetic information (including family medical history), political affiliation, military service, veteran status, other non-merit based factors, or any other characteristic protected by federal, state or local law.