Eligibility Program Lead - Medicaid & Hospital Ops (Hybrid)

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

Benefits offered by this job

Medical, Dental, Vision Insurance

Life Insurance

Short-Term Disability

Long-Term Disability

Critical Illness & Accident Plans

401(k) with up to 4% employer match

Job summary

HealthFund Solutions is seeking an Eligibility Manager in Daytona Beach, FL to oversee daily operations for HealthFund Solutions employees at the hospital site.

You will attend meetings, process rollovers, review QA, audit accounts, and coordinate with caseworkers and management. The role requires strong confidentiality, HIPAA compliance, and communication skills, with hybrid work options.

Qualifications

• High school required.
• Associate’s degree preferred.
• Thorough knowledge of Florida Medicaid and Social Security Disability eligibility criteria.
• Florida Medicaid and Social Security Disability application experience preferred.
• Ability to maintain confidentiality and follow HIPAA guidelines.
• Strong communication and organizational skills.
• Valid driver’s license with clean driving record and active auto insurance.
• Remote/Hybrid work may be required with minimum 75Mbps internet and reliable cellular signal.

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.
• Assist with patient refusals by communicating actions to hospital leadership.
• Review Rollover Report and assign rollovers to staff.
• Complete and send QA Reviews.
• Audit accounts and file hearings as needed.
• Regularly communicate with hospital staff or upper management.
• Address billing issues with hospital staff (e.g., Charity reversals).
• Develop professional relationships with HFS and hospital staff.
• Work Open MCD and Commercial Insurance discovery daily.
• Make weekly visits to other facilities.
• May require working evenings, weekends, and some holidays.
• Assist onsite caseworkers with screening or submitting applications.

Skills

Communication skills

Organizational skills

Data entry

HIPAA knowledge

Bilingual

Education

High school diploma

Associate’s degree preferred

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.