[Hiring] Eligibility Manager @Elevated Community Health

Role Description

The Eligibility Manager leads the Eligibility Department and Community Resource Coordinator, overseeing daily operations, staff performance, workflows, complex determinations, and compliance. As the subject matter expert for eligibility, financial assistance, insurance coverage, public benefits, and patient resources, the manager partners with clinical, registration, revenue cycle, billing, and leadership teams to improve access, reduce errors and delays, and connect patients with appropriate resources.

The Director will support ECH's Access, Stewardship, and Quality (ASQ) priorities by:

• Improving access to care through efficient revenue cycle processes that reduce barriers to services.
• Promoting stewardship through effective revenue cycle operations and financial performance.
• Enhancing quality through accurate, compliant revenue cycle practices and positive patient financial experience.

Essential Functions

• Department Leadership and Operations:
  • Plans, organizes, assigns, directs, and reviews the work of the Eligibility Department and Community Resource Coordinator.
  • Provides effective leadership, supervision, coaching, and performance management to eligibility and community resource staff.
  • Establishes, maintains, and continuously improves department workflows, procedures, and standards.
  • Monitors department workload, productivity, turnaround times, accuracy, and other performance indicators.
  • Ensures staff has the knowledge, resources, and support necessary to determine and document patient eligibility and financial assistance.
  • Provides guidance and support to staff regarding complex or unusual eligibility situations.
• Eligibility, Financial Assistance, and Patient Access:
  • Oversees the accurate and timely determination of patient eligibility for applicable healthcare programs.
  • Maintains working knowledge of programs and resources available to uninsured, underinsured, and low-income patients.
  • Ensures eligibility and financial assistance processes are applied consistently.
  • Supports accurate application of financial assistance and sliding fee policies.
  • Identifies barriers that may prevent patients from accessing care.
  • Ensures patients receive clear, understandable information about available services.
  • Provides guidance when patients are determined to be ineligible for a service or program.
  • Ensures patients are connected to appropriate community resources.
• Compliance, Accuracy, and Quality:
  • Ensures eligibility documentation is complete, accurate, timely, and maintained.
  • Conducts or oversees case reviews and quality audits.
  • Develops and implements corrective actions and process improvements.
  • Maintains current knowledge of changes to eligibility programs and regulations.
  • Collaborates with leadership and other departments to ensure eligibility practices support accurate patient accounts.
  • Participates in quality assurance and performance improvement activities.
• Patient and Internal Customer Service:
  • Communicates professionally and respectfully with patients, families, staff, and other stakeholders.
  • Responds appropriately to patient questions, concerns, and complaints.
  • Handles sensitive financial and personal information with discretion.
  • Uses clear, culturally responsive, and patient-centered communication methods.
  • Demonstrates empathy and respect when working with patients.
  • Promotes a positive patient experience by ensuring eligibility concerns are addressed promptly.
• Collaboration and Teamwork:
  • Collaborates effectively with various departments to support coordinated patient access.
  • Works with community organizations and external agencies to connect patients with resources.
  • Provides education and support to other departments regarding eligibility processes.
  • Demonstrates strong interpersonal, communication, and problem-solving skills.

Qualifications

• Associate or bachelor's degree in healthcare or business administration, social services, or a related field, or equivalent work experience.
• 3 years' experience in eligibility, financial assistance, healthcare access, or related healthcare setting.
• 2 years of supervisory experience.
• Knowledge of CO Medicaid, Medicare, and other public health benefits programs.
• Strong written and verbal communication skills.
• Ability to manage multiple priorities and meet deadlines in a fast-paced environment.
• Ability to communicate effectively and respectfully with diverse individuals.

Requirements

• Complete all required training as designated by Human Resources and the position supervisor.
• Adhere to all organizational policies and those outlined in the Elevated Community Health Employee Handbook.
• Comply with all applicable Elevated Community Health vaccine mandates.
• Ability to travel and work at other Elevated Community Health locations as determined by the supervisor.
• Embrace the Elevated Community Health Mission and Vision.
• Maintain confidentiality and comply with all applicable privacy and information security requirements.

Benefits

• Insured group health, dental, and vision plans.
• 401 (k) retirement plan with employer match.
• Employer-paid life, AD&D, and long-term disability plans.
• Paid Time Off (PTO), paid holidays, one floating holiday, and sick pay.
• Free access to confidential resources through an Employee Assistance Program (EAP).
• Additional voluntary benefits include accident insurance, critical illness insurance, and short-term disability insurance.
• Lifestyle Spending Account for full-time employees.
• Fringe benefits like a shared ski medallion and a discounted Rec Center membership.