Mgr Eligibility Program, Marshall Medical Centers, Full time, 1st Shift

Primary Responsibilities

• Serve as the single point of contact for the third-party eligibility vendor.
• Carry out regular performance reviews, escalate systemic issues, negotiate process improvements, and ensure contractual service levels are met.
• Design, document, and maintain eligibility verification workflows across all access points (inpatient, outpatient, ED, and scheduled services).
• Identify gaps, eliminate redundancies, and build repeatable processes that reduce manual intervention.
• Track eligibility verification rates, turnaround times, error rates, and denial trends.
• Present performance metrics to leadership and recommend corrective actions when benchmarks are not met.
• Partner with patient access, health information management, coding, and billing teams to resolve eligibility-related denials and payer discrepancies.
• Serve as a subject matter expert in eligibility and benefits interpretation.
• Train registration and access staff on eligibility tools, payer requirements, and exception handling.
• Develop reference materials and serve as a resource for escalated cases.
• Stay current on payer policy changes, CMS regulations, and state Medicaid requirements.
• Ensure eligibility processes remain compliant and reflect current coverage rules.

Qualifications

• A high school diploma or GED.
• Bachelor’s degree in healthcare administration, business administration, or a related field is preferred.
• Prior experience in the healthcare environment and/or customer service is preferred.
• A working knowledge of computers and systems to include Microsoft Word, Excel, and Outlook are necessary.
• The ability to communicate in a pleasant, professional, concise, and caring manner.
• Critical thinking and problem solving skills to ensure the best care possible for our patients.
• Bi-lingual is preferred.