Manager, Eligibility and Benefits

Boomerang Healthcare; Walnut Creek (CA); A distancia; USD 87.000 - 104.000; Jornada completa

Ventajas ofrecidas por este puesto de trabajo

Medical, Dental, Vision benefits (PPO,

401(k) Plan with Employer Matching

License & Tuition Reimbursements

Paid Time Off

Holiday Pay & Floating Holiday

Employee Perks and Discount Programs

Descripción de la vacante

Boomerang Healthcare is seeking a Manager of Eligibility & Benefits to oversee insurance verification, financial clearance, and point-of-service collection activities across specialties. You will standardize workflows, ensure accurate data entry, and drive revenue retention by ensuring timely patient payments.

This remote role requires leadership in a healthcare revenue cycle and expertise with major payer portals, EHR systems, and Excel-driven analyses to minimize denials and optimize

Formación

• Minimum 5 years of experience in healthcare revenue cycle, patient access, eligibility, benefits, or related experience.
• Experience with Medicare and commercial insurance plans.
• Strong understanding of deductibles, copays, coinsurance, out-of-pocket maximums, referrals, prior authorization requirement, coordination of benefits.
• 2–3 years of direct supervisory or management experience leading healthcare administrative teams.
• Expert-level understanding of commercial insurance products, including HMO, PPO, and EPO.
• Advanced proficiency in Microsoft Excel (formulas, pivot tables) and other Office applications.
• Experience with enterprise-level EHR platforms (Epic, IMS, eClinicalWorks) and integrated payment collection software.

Responsabilidades

• Supervise, train, and schedule eligibility verification and insurance specialist teams.
• Ensure estimated patient financial responsibility is identified prior to service whenever information is available.
• Communicate expected copays, deductibles, coinsurance, and other patient responsibility clearly.
• Establish escalation procedures for high-dollar patient responsibility or benefit limitations.
• Oversee eligibility verification workflows across diverse clinical lines (specialty to high-cost surgery/diagnostics).
• Analyze denial data with billing/coding teams and implement root-cause fixes for eligibility-related denials.
• Serve as primary administrator for major payer portals (Availity, Optum, UnitedHealthcare, Anthem).
• Assume other responsibilities as appropriate.

Conocimientos

Leadership

Process improvement

Payer knowledge

EHR proficiency

Excel skills

Communication

Herramientas

Epic

IMS

eClinicalWorks

Descripción del empleo

The Manager of Eligibility & Benefits directs the daily operations of the insurance verification, financial clearance, and point-of-service collection teams across all clinical specialties. This role is responsible for standardizing electronic eligibility workflows, ensuring accurate coverage of data entry, and eliminating front-end office claim denials. Additionally, the manager drives revenue retention by implementing strict processes that ensure patient co-pays, deductibles, and outstanding prior balances are accurately calculated and successfully collected prior to or on the date of service.

*This is a remote role

What you will do:

• Supervise, train, and schedule eligibility verification and insurance specialist teams.
• Ensure estimated patient financial responsibility is identified prior to service whenever information is available
• Support accurate communication of expected copays, deductibles, coinsurance, and other patient responsibility
• Establish escalation procedures for high-dollar patient responsibility, coverage exclusions, or benefit limitations requiring additional patient communication
• Multi-Specialty Workflow Management: Oversee eligibility verification workflows for diverse clinical lines, ranging from specialty care to high-cost surgical and diagnostic specialties
• Denial Prevention: Partner with the billing and coding teams to analyze backend rejection data and implement root-cause fixes for eligibility-related claim denials
• Payer Portal Governance: Serve as the primary administrator for major commercial payer portals (E.g., Availity, Optum, United Healthcare, Anthem) to resolve complex coverage issues
• Assumes other responsibilities as appropriate to the position and organizational needs

Qualifications:

• Minimum 5 years of experience in healthcare revenue cycle, patient access, eligibility, benefits, or related experience
• Experience working with Medicare and commercial insurance plans
• Strong understanding of deductibles, copays, coinsurance, out-of-pocket maximums, referrals, prior authorization requirement, coordination of benefits
• Process Improvement Expertise: Proven track record of managing and improving front-end or point-of-service collection rates in a healthcare setting
• Leadership: At least 2-3 years of direct supervisory or management experience leading healthcare administrative teams
• Payer Knowledge: Expert-level understanding of commercial insurance products, including HMO, PPO, and EPO.
• System Proficiency: Advanced, hands-on experience utilizing enterprise-level EHR platforms (e.g. Epic, IMS, e-Clinical Works) and integrated payment collection software
• Advanced proficiency in Microsoft Excel (e.g., formulas, pivot tables) and solid skills in other Microsoft Office applications

Compensation Range:

$87,360 - $104,000 annually

All compensation ranges are posted based on internal equity, job requirements, experience, and geographical locations.

Why You'll Love Working Here:

• Amazing work/life balance
• Generous Medical, Dental, Vision, and Prescription benefits (PPO & HMO)
• 401(K) Plan with Employer Matching
• License & Tuition Reimbursements
• Paid Time Off
• Holiday Pay & Floating Holiday
• Employee Perks and Discount Programs
• Supportive environment to help you grow and succeed

Boomerang Healthcare (BHC) is a multidisciplinary and comprehensive team of experienced, committed healthcare providers that treat pain. Our team of doctors approaches each patient with one goal in mind: to help patients return to normal daily activities. We work with our patients to identify the cause of their pain and create a personalized treatment plan, recognizing that no two patients are alike, and neither is their pain. Our providers create a comprehensive care plan, then monitor, manage and coordinate patient access to health services at BHC.

Boomerang Healthcare strives to be a diverse workforce that reflects, at all job levels, the patients we serve. We are an equal opportunity employer. Boomerang Healthcare is committed to compliance with the American Disabilities Act. If you require reasonable accommodation during the application process or have a question regarding an essential job function, please contact us.