Manager, Eligibility and Benefits

About the role

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.

Responsibilities

• 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.
• Absorbs 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 requirements, 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.

Benefits

• Compensation Range: $87,360 - $104,000 annually.
• Amazing work/life balance.
• Generous Medical, Dental, Vision, and Prescription benefits (PPO & HMO).
• 401(K) Plan with Employer Matching.
• Licensing & Tuition Reimbursements.
• Paid Time Off.
• Holiday Pay & Floating Holiday.
• Employee Perks and Discount Programs.
• Supportive environment to help you grow and succeed.

Why You'll Love Working Here

• Boomerang Healthcare (BHC) is a multidisciplinary and comprehensive team of experienced, committed healthcare providers that treat pain.
• We approach each patient with one goal in mind: to help patients return to normal daily activities.
• We work with our patients to identify the cause of their pain and create a personalized treatment plan, recognizing that no two patients are alike, and neither is their pain.
• We create a comprehensive care plan, then monitor, manage, and coordinate patient access to health services at BHC.
• We strive to be a diverse workforce that reflects, at all job levels, the patients we serve.
• We are an equal opportunity employer.
• We are committed to compliance with the American Disabilities Act.