Billing Operations Manager – Eligibility

Role Overview

• Lead and manage the Eligibility team, ensuring accurate and timely insurance verification, prior authorizations, and benefit assessments
• Develop and monitor team performance metrics, ensuring goals are met for turnaround time, accuracy, and payer compliance
• Collaborate with payers to resolve eligibility discrepancies, denials, and escalations
• Work closely with Revenue Cycle leadership to identify trends, gaps, and opportunities for process improvements
• Implement and update policies and procedures to ensure compliance with regulatory and payer requirements
• Train, coach, and mentor team members to enhance knowledge of payer guidelines, systems, and best practices
• Partner with cross-functional teams Billing to support a seamless patient and provider experience
• Provide regular reporting and analysis of eligibility performance, including KPIs, denial trends, and payer turnaround times
• Manage staffing schedules, workload distribution, and productivity standards to ensure operational coverage and efficiency
• Support system implementations, testing, and enhancements related to eligibility processes
• Provide strategic direction, coaching, and professional development to foster a high-performance culture
• Lead by example and promote a culture of accountability and continuous improvement
• Identify and implement process enhancements to improve efficiency, reduce error rates, and support scalability
• Standardize procedures and documentation across the department
• Evaluate and implement technology solutions and reporting tools to support automation and performance tracking
• Ensure adherence to HIPAA, payer rules, and all relevant state and federal regulations
• Stay current on industry best practices, regulatory updates, and payer changes impacting billing and date of service requirements

Requirements

• High School diploma or equivalent required
• 5–7 years of experience in healthcare billing operations, with at least 2–3 years in a supervisory or management role
• Strong knowledge of CPT, ICD-10, HCPCS coding, payer regulations, and revenue cycle management
• Ability to lead cross-functional initiatives and manage timelines, resources, and deliverables
• Experience with Medicare Advantage plans and familiarity with Xifin is a plus
• Demonstrated ability to lead teams, manage change, and drive performance in a fast-paced environment
• Proficiency in Microsoft Office Suite (Excel, Word, Outlook, Access) and healthcare billing systems

Benefits

• Health insurance
• Flexible work arrangements
• Professional development