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.
Why You'll Love Working Here:
- Amazing work/life balance
- Generous Medical, Dental, Vision, and Prescription benefits (PPO & HMO)
- 401(K) Plan with Employer Matching
- License & Tuition Reimbursements
- Paid Time Off
- Holiday Pay & Floating Holiday
- Employee Perks and Discount Programs
- Supportive environment to help you grow and succeed
Monday-Friday, 8am-5pm
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