Eligibility Manager

HealthFund Solutions•Daytona Beach, FL

22h•Hybrid

About The Position

The Eligibility Manager provides strategic and hands on leadership to the Eligibility team at the assigned hospital site. Reporting to the Eligibility Director, this role is responsible for leading staff, cultivating a high performing team culture, and ensuring operational excellence in eligibility processes. The manager serves as the primary onsite leader, fostering strong relationships with both HealthFund Solutions staff and hospital partners. ___________________________________________________________________________________ Key Responsibilities Team Leadership & Employee Management Lead, coach, and develop a team of eligibility staff to achieve performance expectations and high-quality outcomes. Conduct regular 1:1 coaching sessions, performance reviews, and goal-setting conversations with team members. Facilitate weekly team meetings, ensuring agendas are prepared, communicated, and aligned with business priorities. Address employee performance issues through coaching, documentation, and formal disciplinary actions when necessary. Manage staffing needs including attendance tracking, callout reporting, timecard corrections, and scheduling adjustments. Build team morale, encourage collaboration, and create a positive, accountable work environment. Operational Oversight Oversee the daily workflow and productivity of the eligibility team, ensuring timely and accurate processing of all accounts. Review, assign, and monitor rollover cases to ensure balanced workloads and effective case resolution. Conduct QA reviews and audits to ensure compliance, accuracy, and adherence to company standards. Support caseworkers by assisting with patient screenings or application submissions when workload or circumstances require. Support as needed, the Billing/Invoicing Specialist to work Open Medicaid and commercial insurance discovery accounts daily to support revenue operations. Hospital & External Partner Communication Serve as a primary point of contact for hospital leadership and staff, maintaining strong, professional relationships. Attend and facilitate hospital meetings and conference calls to represent HFS and support collaborative decision-making. Communicate updates related to patient refusals, eligibility actions, and program changes to hospital partners. Address billing issues, including charity care adjustments, and coordinate resolutions with hospital teams. Report technical system issues with government agencies, portals, or partner programs as needed. Administrative & Field Responsibilities File and attend hearings when required. Conduct weekly site visits to other assigned facilities to support staff and operational needs. Maintain strict confidentiality and compliance with HIPAA and organizational guidelines. Perform additional duties as required to support evolving business needs. Role may require occasional evenings, weekends, or holiday work. Remote/hybrid work may be required; minimum 75 Mbps home internet and reliable cellular reception are mandatory.

Requirements

High school diploma required; Associate degree preferred.
Strong knowledge of Florida Medicaid and Social Security Disability eligibility criteria.
Experience with Medicaid or SSDI application processing preferred.
Epic or Hospital EMR preferred
Demonstrated ability to lead, motivate, and develop a diverse team.
Strong communication skills—clear, concise, professional verbal and written abilities.
Excellent organizational, administrative, and time management capabilities.
Ability to self-direct, manage multiple priorities, and operate effectively under pressure.
Strong relationship-building skills with both internal staff and external partners.
Effective conflict management and problem-solving skills.
Valid driver's license, clean driving record, and active auto insurance required.
Ability to sit for extended periods while working on a computer.
Ability to lift up to 10 pounds occasionally.
Ability to maintain focus and attention to detail for long periods.
Minimum 75 Mbps home internet and reliable cellular reception are mandatory.

Nice To Haves

Bilingual abilities preferred.
Experience with Medicaid or SSDI application processing preferred.
Epic or Hospital EMR preferred
Associate degree preferred.

Responsibilities

Lead, coach, and develop a team of eligibility staff to achieve performance expectations and high-quality outcomes.
Conduct regular 1:1 coaching sessions, performance reviews, and goal-setting conversations with team members.
Facilitate weekly team meetings, ensuring agendas are prepared, communicated, and aligned with business priorities.
Address employee performance issues through coaching, documentation, and formal disciplinary actions when necessary.
Manage staffing needs including attendance tracking, callout reporting, timecard corrections, and scheduling adjustments.
Build team morale, encourage collaboration, and create a positive, accountable work environment.
Oversee the daily workflow and productivity of the eligibility team, ensuring timely and accurate processing of all accounts.
Review, assign, and monitor rollover cases to ensure balanced workloads and effective case resolution.
Conduct QA reviews and audits to ensure compliance, accuracy, and adherence to company standards.
Support caseworkers by assisting with patient screenings or application submissions when workload or circumstances require.
Support as needed, the Billing/Invoicing Specialist to work Open Medicaid and commercial insurance discovery accounts daily to support revenue operations.
Serve as a primary point of contact for hospital leadership and staff, maintaining strong, professional relationships.
Attend and facilitate hospital meetings and conference calls to represent HFS and support collaborative decision-making.
Communicate updates related to patient refusals, eligibility actions, and program changes to hospital partners.
Address billing issues, including charity care adjustments, and coordinate resolutions with hospital teams.
Report technical system issues with government agencies, portals, or partner programs as needed.
File and attend hearings when required.
Conduct weekly site visits to other assigned facilities to support staff and operational needs.
Maintain strict confidentiality and compliance with HIPAA and organizational guidelines.
Perform additional duties as required to support evolving business needs.