Manager, Eligibility and Benefits

Job Description

Job Description

The Manager of Eligibility & Benefits directs the daily operations of the insurance verification, financial clearance, and point-of-service collection teams across all clinical specialties. This role is responsible for standardizing electronic eligibility workflows, ensuring accurate coverage of data entry, and eliminating front-end office claim denials. Additionally, the manager drives revenue retention by implementing strict processes that ensure patient co-pays, deductibles, and outstanding prior balances are accurately calculated and successfully collected prior to or on the date of service.

*This is a remote role 

What you will do:

• Supervise, train, and schedule eligibility verification and insurance specialist teams.
• Ensure estimated patient financial responsibility is identified prior to service whenever information is available
• Support accurate communication of expected copays, deductibles, coinsurance, and other patient responsibility
• Establish escalation procedures for high-dollar patient responsibility, coverage exclusions, or benefit limitations requiring additional patient communication
• Multi-Specialty Workflow Management: Oversee eligibility verification workflows for diverse clinical lines, ranging from specialty care to high-cost surgical and diagnostic specialties
• Denial Prevention: Partner with the billing and coding teams to analyze backend rejection data and implement root-cause fixes for eligibility-related claim denials
• Payer Portal Governance: Serve as the primary administrator for major commercial payer portals (E.g., Availity, Optum, United Healthcare, Anthem) to resolve complex coverage issues
• Assumes other responsibilities as appropriate to the position and organizational needs

Qualifications:

• Minimum 5 years of experience in healthcare revenue cycle, patient access, eligibility, benefits, or related experience
• Experience working with Medicare and commercial insurance plans
• Strong understanding of deductibles, copays, coinsurance, out-of-pocket maximums, referrals, prior authorization requirement, coordination of benefits
• Process Improvement Expertise: Proven track record of managing and improving front-end or point-of-service collection rates in a healthcare setting
• Leadership: At least 2-3 years of direct supervisory or management experience leading healthcare administrative teams
• Payer Knowledge: Expert-level understanding of commercial insurance products, including HMO, PPO, and EPO.
• System Proficiency: Advanced, hands-on experience utilizing enterprise-level EHR platforms (e.g. Epic, IMS, e-Clinical Works) and integrated payment collection software
• Advanced proficiency in Microsoft Excel (e.g., formulas, pivot tables) and solid skills in other Microsoft Office applications

Compensation Range: 

$87,360 - $104,000 annually

All compensation ranges are posted based on internal equity, job requirements, experience, and geographical locations.