Manager, Patient Eligibility

About the role

Job Title: Manager, Patient Eligibility
Employment Type: Full-Time; Salaried – Exempt
Pay Range: $75,000 – $85,000 annual salary
Work Location(s): Routine travel will be expected to the following facilities to conduct onsite visits and meet with colleagues and client leadership.

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 escalate appropriately.
• Drive continuous improvement initiatives to enhance client satisfaction and operational outcomes.
• 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.

Operational Excellence

• 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.
• Maintain compliance with HIPAA, Medicaid, Charity Care, Disability, and other regulatory guidelines.

Financial Accountability

• Accountable for individual facility level and regional market financial performance, including revenue, expense management, and margin optimization.

Team Management

• Lead, mentor, and develop an eligibility team with both direct and indirect reports, including a supervisor and individual contributors across multiple facilities, ensuring alignment with organizational goals, operational standards, and performance expectations.
• Monitor team and individual performance and quality metrics, providing regular feedback and implement 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.