Manager, Eligibility and Benefits

This is a fully remote position, open to applicants in California.

📋 Description

• Oversee the daily functions of the insurance verification, financial clearance, and point-of-service collection teams across all clinical specialties.

• Standardize workflows for electronic eligibility.

• Ensure precise data entry for coverage information.

• Reduce claim denials at the front-end office.

• Implement rigorous processes to accurately determine and collect patient co-pays, deductibles, and outstanding prior balances before or on the date of service.

• Supervise, train, and schedule teams of eligibility verification and insurance specialists.

• Confirm that estimated patient financial responsibilities are identified prior to service whenever information is accessible.

• Facilitate accurate communication regarding expected copays, deductibles, coinsurance, and other patient responsibilities.

• Establish procedures for escalating high-dollar patient responsibilities, coverage exclusions, or benefit limitations that necessitate further patient communication.

• Manage eligibility verification workflows across various clinical lines, from specialty care to high-cost surgical and diagnostic specialties.

• Collaborate with billing and coding teams to analyze backend rejection data and implement root-cause solutions for eligibility-related claim denials.

• Act as the primary administrator for major commercial payer portals such as Availity, Optum, United Healthcare, and Anthem.

• Assume additional responsibilities as necessary based on the position and organizational requirements.

⛳️ Requirements

• A minimum of 5 years of experience in healthcare revenue cycle, patient access, eligibility, benefits, or a related field.

• Experience with Medicare and commercial insurance plans.

• Strong knowledge of deductibles, copays, coinsurance, out-of-pocket maximums, referrals, prior authorization requirements, and coordination of benefits.

• Proven success in managing and enhancing front-end or point-of-service collection rates within a healthcare environment.

• At least 2-3 years of direct supervisory or management experience leading healthcare administrative teams.

• Expert-level knowledge of commercial insurance products, including HMO, PPO, and EPO.

• Advanced, hands-on experience with 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).

• Solid skills in various other Microsoft Office applications.

• Availability Monday to Friday, 8am to 5pm.

• 40 hours per week.

🏝️ Benefits

• Excellent work/life balance.

• Comprehensive 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 foster your growth and success.