Financial Eligibility Manager

The Financial Eligibility Manager serves as the primary contact for all Benefits and Eligibility aspects of the Client’s treatment, including insurance verification and cost inquiries. This role is crucial in ensuring timely authorizations and effective precertification processes, ultimately maximizing financial reimbursement for the agency. The Manager oversees a team responsible for Medicaid Enrollment, DMH Enrollment, Financial Eligibility Reporting, Guarantor Assignment/Reviews for accuracy, and Benefits Advocacy Services/Sliding Fee Scale Administers.

POSITION SPECIFIC DUTIES & RESPONSIBILITIES:

• Oversee and implement the Benefits and Eligibility team, including staffing and operational processes.

• Develop work plans and strategies for the team.

• Resolve complex operational issues, such as ‘Guarantor Assignment’, and establish management practices to address any ongoing issues in this respect.

• Work closely with other Revenue Cycle leaders to implement new processes and training to prevent denials and delayed reimbursements.

• Establish and support agency-wide Financial Eligibility processes from Prior Authorizations to benefit verification.

• Monitor team progress based on performance benchmarks and address issues as they arise.

• Active participant in Revenue Cycle Monthly Operational Reviews to address denial trends.

• Develop and monitor metrics highlighting the viability of the team.

• Recommend improvements to streamline operational and system problems.

• Must adopt a “working” Manager philosophy.

• Other duties, tasks, and responsibilities as assigned.

QUALIFICATIONS 

education: 

• Bachelor's Degree in related field is required 

• Combination of Experience and Education considered in lieu of Education requirements on a case by case basis. 

EXPERIENCE: 

• 7+ years' experience in healthcare, preferably Behavioral Health.

• Experience with billing through Electronic Health Records.

• Supervisory experience required.

PERFORMANCE COMPETENCIES:  

• Communication 

• Decision-Making 

• Engagement 

• Initiative/Accountability 

• Interpersonal 

• Learning 

• Organizational Alignment 

• Quality of Work 

KNOWLEDGE/SKILLS/ABILITIES: 

• Knowledge of government and commercial insurance procedures, regulations and billing requirements.

• Strong analytical and organization skills.

•  Ability to lead and/or work as a member of various cross-functional teams.

• Excellent written and oral communication skills.

• Strong understanding of quality customer service.

• Profecient in Microsoft Suite.

CERTIFICATIONS/LICENSES: 

• N/A 

OTHER INFORMATION 

SAFETY SENSITIVE JOB CLASSIFICATION: 

This job is classified as a “safety-sensitive” position as defined by the Oklahoma Medical Marijuana and Patient Protection Act. Due to the “safety-sensitive” classification, an employee in this position would be subject to drug and alcohol testing, including random testing. Marijuana is one of the substances included in the drug panel screening. Possession of a medical marijuana license will not excuse you from the testing process or the consequences of testing positive for marijuana per the Family & Children’s Services Drug Free Workplace Policy, including possible revocation of a job offer or dismissal from employment.