Healthcare Operations -Eligibility Monitoring

Full-time

BCforward

BCforward is seeking a Healthcare operations professional with deep experience in eligibility decisioning, validation, and analytics, ensuring high accuracy while maintaining strict compliance and data privacy standards.

Program Eligibility and Monitoring Consultant

Location: Indianapolis, IN Hybrid

Job Description

We are seeking a Program Eligibility and Monitoring Consultant to join our dynamic team. The ideal candidate will have strong experience in patient assistance program eligibility operations, compliance monitoring, and data-driven process improvement and a proven ability to optimize eligibility workflows, uphold privacy requirements, and deliver actionable monitoring insights. This individual will apply documented eligibility criteria and decision rules to review cases, flag anomalies, and escalate suspected program integrity issues, including potential Alternative Funding Plan (AFP) indicators.

Must-Have Focused Candidate Summary

Program Eligibility & Monitoring Consultant with 5+ years of experience in eligibility operations, decision-making, and high-accuracy case processing within healthcare or patient assistance programs. Demonstrated ability to interpret complex insurance and program criteria to make accurate eligibility determinations while maintaining strict adherence to compliance standards.

Strong expertise in monitoring and validation , including auditing approved and denied cases, identifying discrepancies, and ensuring consistency in eligibility decisions. Leverages data analytics to detect trends, perform root-cause analysis, and drive continuous process improvement.

Deep understanding of privacy and compliance , including secure handling of sensitive patient data, enforcement of access controls, and adherence to data retention policies (HIPAA-aligned). Proven track record of maintaining data integrity while supporting operational efficiency.

Must-Have Skills

Eligibility Operations
Hands-on eligibility review (PAP, insurance, benefits verification)
Applies program rules to make independent decisions
Decision-Making & Accuracy
High-volume case processing with strong attention to detail
Low error rates / audit accuracy experience
Monitoring & Validation
Conducts audits of approvals/denials
Builds or executes validation/QA frameworks
Analytics
Uses data to identify trends, discrepancies, root causes
Experience with reporting, dashboards, or Excel/SQL
Compliance & Privacy
HIPAA knowledge
Data access controls, retention policies, secure handling of PHI

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Vacancy posted 7 hours ago

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