Manager, Eligibility and Benefits

Integrated Pain Management Medical Group, Inc.•Walnut Creek, CA

4d•$42 - $50•Remote

About The Position

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. This is a remote role.

Requirements

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 requirement, coordination of benefits
Proven track record of managing and improving front-end or point-of-service collection rates in a healthcare setting
At least 2-3 years of direct supervisory or management experience leading healthcare administrative teams
Expert-level understanding of commercial insurance products, including HMO, PPO, and EPO.
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

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
Oversee eligibility verification workflows for diverse clinical lines, ranging from specialty care to high-cost surgical and diagnostic specialties
Partner with the billing and coding teams to analyze backend rejection data and implement root-cause fixes for eligibility-related claim denials
Serve as the primary administrator for major commercial payer portals (E.g., Availity, Optum, United Healthcare, Anthem) to resolve complex coverage issues
Assumes other responsibilities as appropriate to the position and organizational needs