Manager, Patient Eligibility

Responsibilities

• Serve as the primary operational leader for a major client(s) within multiple regions, managing $3.0M+ in revenue.
• Own day‑to‑day client relationships, ensuring service level agreements (SLAs), quality standards, and performance expectations are met.
• Lead client meetings as appropriate; prepare, review, and present weekly, monthly and quarterly operational reports.
• Proactively identify service risks, performance gaps, or potential contractual concerns and escape appropriately.
• Drive continuous improvement initiatives to enhance client satisfaction and operational outcomes.
• Act as an escalation point for complex cases, working with internal and external stakeholders to resolve issues promptly.
• Partner with hospital leadership, government agencies, and other departments to ensure seamless processes and patient care.
• Travel regularly to assigned facilities, ensuring timely and efficient support across multiple locations within the service area.
• Complete special projects, as assigned.
• Manage workload distribution and inventory management across the team, aligning capacity with demand to drive efficiency, productivity, and service level performance.
• Oversee workflow execution, productivity, and quality assurance processes to ensure timely and accurate processing of eligibility accounts.
• Ensure adherence to QA standards; review audit results, implement remedial training and/or corrective actions, and monitor sustained improvement.
• Use multiple systems and databases to gather, track, and report on patient data.
• Develop, refine, and enforce policies and procedures to align with regulatory, compliance, and client requirements.
• Identify opportunities to improve processes, leverage technology, and enhance eligibility workflows.
• Monitor compliance with HIPAA, Medicaid, Charity Care, Disability, and other regulatory guidelines.
• Accountable for individual facility level and regional market financial performance, including revenue, expense management, and margin optimization.
• Lead, mentor, and develop an eligibility team with both direct and indirect reports, ensuring alignment with organizational goals, operational standards, and performance expectations.
• Monitor team and individual performance and quality metrics, providing regular feedback and implementing corrective action and performance improvement plans as necessary.
• Oversee hiring, onboarding, performance management, coaching, corrective actions, and terminations in partnership with HR.
• Manage workforce planning, scheduling, overtime oversight, travel expenditures and resource allocation to ensure productivity and coverage standards are achieved.
• Ensure colleagues receive appropriate training, tools, and development opportunities to perform effectively.
• Partner with the Eligibility Specialist III and Revenue Cycle Training team to create and deliver training programs, ensuring colleagues are equipped with knowledge and skills needed to succeed in their roles.

• Bachelor’s Degree in healthcare administration, business, other related field or a combination of education and/or equivalent experience.
• At least 5 years of experience in healthcare eligibility, financial counseling, or case management roles.
• At least 5 years of people management experience, managing team sizes greater than 20 employees.
• Familiarity with state and federal assistance programs such as Medicaid, Medicare, and Social Security Disability.
• Proven ability to lead and motivate teams, fostering a culture of collaboration and accountability.
• Excellent problem‑solving skills, with ability to de‑escalate and/or resolve complex patient or operational issues.
• Strong organizational skills with the ability to handle multiple priorities and maintain accuracy and attention to detail.
• Excellent verbal and written communication skills, with the ability to explain complex information clearly and empathetically.
• Ability to identify solutions to financial challenges, leveraging program knowledge to benefit patients.
• Capability to work in a fast‑paced environment with changing priorities and patient needs.
• Reliable transportation, a valid driver’s license, and ability to travel within assigned service area.