Financial Eligibility Manager

Family & Children’s Services; Tulsa (OK); On-site; USD 70,000 - 100,000; Full time

Job summary

Family & Children’s Services in Tulsa, OK seeks a Financial Eligibility Manager to lead the Benefits and Eligibility team, manage Medicaid enrollment and cost verification, and optimize revenue cycle performance. The role focuses on timely authorizations, accurate guarantor assignments, and proactive denials prevention.

The ideal candidate will have a Bachelor's degree, 7+ years in healthcare, supervisory experience, and strong knowledge of insurance procedures and EHR billing.

Qualifications

• Bachelor's degree required; combination of experience and education considered in lieu of education on a case-by-case basis.
• 7+ years of experience in healthcare, preferably Behavioral Health.
• Supervisory experience required.
• 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 cross-functional teams.
• Excellent written and oral communication skills.
• Proficient in Microsoft Suite.

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 address ongoing issues.
• Work with Revenue Cycle leaders to prevent denials and delays in 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.
• Participate in Revenue Cycle Monthly Operational Reviews to address denial trends.
• Develop and monitor metrics highlighting the team’s viability.
• Recommend improvements to streamline operations and systems.
• Adopt a working Manager philosophy.
• Other duties, tasks, and responsibilities as assigned.

Skills

7+ years healthcare experience

Supervisory experience

Billing through EHR

Cross-functional collaboration

Strong communication

Microsoft Office

Education

Bachelor's Degree in related field

Tools

Electronic Health Records (EHR)

Microsoft Office

Job description

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.

Education

Required

Bachelors or better.

Experience

Preferred

7 years: Experience in healthcare.

Equal Opportunity Employer/Protected Veterans/Individuals with Disabilities
This employer is required to notify all applicants of their rights pursuant to federal employment laws.For further information, please review the Know Your Rights notice from the Department of Labor.