Manager, Eligibility

WelbeHealth

About The Position

At WelbeHealth, each participant of our program is guided by our interdisciplinary team (IDT), composed of clinical and non-clinical members who work cohesively to provide all-inclusive care to our most vulnerable senior population. At WelbeHealth, the Manager, Eligibility is a pivotal role responsible for ensuring the smooth operation of Medicaid and Medicare coverage maintenance and the accuracy and integrity of eligibility data across all systems. While overseeing the Eligibility team, this leader will drive efforts to maintain uninterrupted participant coverage, safeguard revenue, and uphold strict compliance standards. They will serve as the central link between central operations, market-level leaders, and external partners to ensure that all participant data is accurate, current, and seamlessly integrated for all WelbeHealth PACE programs. The Manager, Eligibility is a member of the WelbeHealth leadership team and facilitates collaborative relationships across WelbeHealth and with external stakeholders to promote WelbeHealth values, team culture and mission.

Requirements

Bachelor’s Degree in relevant field preferred
Minimum of five (5) years’ experience working in healthcare or social services administration is required
Minimum of three (3) years of experience interacting with local government Medicaid or Social Security agencies required
Minimum of one (1) year of experience working with Medicare eligibility and Center for Medicare and Medicaid Services
Two (2) years’ supervisory experience with demonstrated ability to mentor and develop team members
Experience leading in a data-driven organization, leveraging reports and data to prioritize and manage people and projects

Nice To Haves

Experience working in a larger scale company environment is highly desired

Responsibilities

Lead our Eligibility team to ensure our participants maintain eligibility for PACE services through proactive management including but not limited to establishing strategies, tools and management processes that prevent eligibility discrepancies
Leverage advanced data analytics and a deep understanding of regulatory requirements, to proactively identify and mitigate risks pertaining to participant eligibility; ensure reporting accuracy by supervising the verification of eligibility data in key reports, such as encounter and prescription drug event reporting
Oversee participant demographic, eligibility and enrollment data integrity across Welbe systems
Monitor revenue impact by directing the analysis of eligibility data, identifying potential financial risks, and ensuring that these risks and outcomes are communicated to finance teams and local programs
Effectively communicate risks and outcomes to key stakeholders while engaging in a collaborative process that transforms complex data into actionable insights that result in timely decision-making
Coordinate with local market leaders by directing efforts to identify and prioritize high impact discrepancies, ensuring the team executes corrective actions efficiently and effectively
Liaise with county and state agencies and other governmental agencies to verify continuous eligibility for Welbe participants and ensuring participants’ Medicaid and Medicare coverage is correctly attributed