Eligibility Manager-Daytona Beach, Fl.

HealthFund Solutions LLC; Daytona Beach (FL); On-site; USD 42,000 - 64,000; Full time

Job summary

HealthFund Solutions LLC is seeking an Eligibility Manager to oversee daily operations at the Daytona Beach hospital site. You will coordinate meetings, manage eligibility determinations for Florida Medicaid and Social Security Disability, handle audits and reporting to the Eligibility Assistant Director, and mentor staff while ensuring HIPAA compliance.

The role requires strong communication, organizational, and problem-solving skills, flexibility to cover evenings or weekends, and a commitment

Qualifications

• High school diploma required.
• Associate degree preferred.
• Strong knowledge of Florida Medicaid and SSDI eligibility.
• Experience with HIPAA and confidentiality.
• Excellent communication and organization skills.
• Bilingual preferred.

Responsibilities

• Attend and facilitate hospital meetings and conference calls.
• Manage eligibility determinations and rollovers to caseworkers.
• Report callouts, timecard corrections, and attendance to director.
• Audit accounts and file hearings as needed.
• Develop professional relationships with hospital staff and HealthFund Solutions colleagues.

Skills

Communication

Organization

Time management

HIPAA/compliance

Problem-solving

Bilingual (English/Spanish)

Education

High school diploma

Associate’s degree

Job description

Description

The Eligibility Manager is responsible for overseeing the daily operations and HealthFund Solutions employees of the assigned hospital site in Daytona Beach, Fl.

Benefits:

• Medical, Dental, and Vision Insurance
• Life Insurance
• Short-Term and Long-Term Disability
• Critical Illness & Accident Plans
• 401(k) with up to 4% employer match

Responsibilities:

• Attend and facilitate hospital meetings and conference calls
• Send follow-ups and rollovers to caseworkers daily
• Send out agenda for weekly staff meetings to management
• Report callouts, timecard corrections, and tardiness to the Eligibility Assistant Director
• Facilitate disciplinary action meetings with staff members
• Assist with patient refusals by communicating actions and updates to hospital leadership
• Review Rollover Report and assign all rollovers to the appropriate staff member
• Complete and send QA Reviews
• Audit accounts
• File and attend hearings as needed
• Communicate on a regular basis with hospital staff or upper management
• Report on any technical issues with different agencies, services, and programs
• Address with hospital staff any billing issues that need to be corrected (i.e. Charity reversal)
• Develop and retain a professional relationship with HFS staff and hospital staff
• Work Open MCD and Commercial Insurance discovery daily
• Make weekly visits to other assigned facilities
• May require working evenings, weekends, and some holidays
• Assist onsite caseworkers with screening or submitting applications as needed
• Other duties as assigned by Upper Management

Requirements:

• High school required
• Associate’s degree preferred
• Thorough knowledge and understanding of Florida Medicaid and Social Security Disability eligibility criteria
• Florida Medicaid and Social Security Disability application experience preferred
• Ability to maintain and respect confidentiality and HIPPA guidelines
• Highly effective in working with a diverse group of people
• Must demonstrate communication, organizational, and administrative skills
• Excellent time management skills
• Ability to self-direct work
• Effective stress coping skills
• Bilingual preferred
• The ability to communicate clearly and concisely is required
• Excellent verbal and written communication skills
• Must have valid driver’s license with clean driving record and active auto insurance
• *Remote/Hybrid – at any point, if required to work from home a minimum internet speed of 75Mbps and reliable cellular signal is required to be able to do this job effectively

Physical Abilities:

While performing the duties of this job

• Ability to sit for long periods of time entering data into the computer
• Ability to occasionally lift up to 10 pounds
• Ability to concentrate and stay on task for long periods of time

NOTE:

This job description is not intended to be all-inclusive. Duties may be adjusted as needed to meet organizational needs.

All candidates must successfully pass a national background check and a 12-panel drug screening. HealthFund Solutions is a drug-free workplace.

We are an equal opportunity employer. All qualified applicants will be considered without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or veteran status.