Mgr Eligibility Program, Marshall Medical Centers, Full time, 1st Shift
About The Position
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.
Requirements
- High school diploma or GED
- Certification through Medicaid as an Application Assister and to award HPE
- Working knowledge of computers and systems to include Microsoft Word, Excel, and Outlook
- Ability to communicate in a pleasant, professional, concise, and caring manner
- Critical thinking and problem solving skills
Nice To Haves
- Bachelor’s degree in healthcare administration, business administration, or a related field
- Prior experience in the healthcare environment and/or customer service
- Bi-lingual
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.
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What This Job Offers
Job Type
Full-time
Career Level
Manager
Education Level
High school or GED
Number of Employees
1,001-5,000 employees
