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

Overview

The following statements reflect the general duties considered necessary to describe the principal functions of the job as identified and shall not be considered as a detailed description of all the work requirements, which may be inherent in the position.

Position Summary:  The Eligibility Program Manager will serve as the on-site liaison between Marshall Medical Centers and our third party insurance eligibility vendor.  This role is responsible for ensuring timely, accurate verification of patient insurance benefits and for building the internal processes and accountability structures needed to keep eligibility operations running smoothly. The manager will own the day-to-day vendor relationship, drive performance standards, and partner with registration, billing, and clinical teams to reduce denials and improve the patient financial experience.  They must maintain compliance with current guidelines and all federal, state, and local laws pertaining to these programs. 

Primary Responsibilities:

·        Serve as the single point of contact for the third-party eligibility vendor. Conduct 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

This position requires, at minimum, 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. This position requires certification through Medicaid as an Application Assister and to award HPE.  A working knowledge of computers and systems to include Microsoft Word, Excel, and Outlook are necessary.  This position requires the ability to communicate in a pleasant, professional, concise, and caring manner. It also requires critical thinking and problem solving to ensure the best care possible for our patients.  Bi-lingual is preferred.