Eligibility Program Manager

Overview

The following statements reflect the general duties considered necessary to describe the principal functions of the job as identified and shall not be considered as a detailed description of all the work requirements, which may be inherent in the position.

Position Summary:  The Eligibility Program Manager will serve as the on-site liaison between Marshall Medical Centers and our third party insurance eligibility vendor.  This role is responsible for ensuring timely, accurate verification of patient insurance benefits and for building the internal processes and accountability structures needed to keep eligibility operations running smoothly. The manager will own the day-to-day vendor relationship, drive performance standards, and partner with registration, billing, and clinical teams to reduce denials and improve the patient financial experience.  They must maintain compliance with current guidelines and all federal, state, and local laws pertaining to these programs. 

Primary Responsibilities:

·        Serve as the single point of contact for the third-party eligibility vendor. Conduct regular performance reviews, escalate systemic issues, negotiate process improvements, and ensure contractual service levels are met.

·        Design, document, and maintain eligibility verification workflows across all access points (inpatient, outpatient, ED, and scheduled services). Identify gaps, eliminate redundancies, and build repeatable processes that reduce manual intervention.

·        Track eligibility verification rates, turnaround times, error rates, and denial trends. Present performance metrics to leadership and recommend corrective actions when benchmarks are not met.

·        Partner with patient access, health information management, coding, and billing teams to resolve eligibility-related denials and payer discrepancies. Serve as a subject matter expert in eligibility and benefits interpretation.

·        Train registration and access staff on eligibility tools, payer requirements, and exception handling. Develop reference materials and serve as a resource for escalated cases.

·        Stay current on payer policy changes, CMS regulations, and state Medicaid requirements. Ensure eligibility processes remain compliant and reflect current coverage rules.

Qualifications

This position requires, at minimum, a high school diploma or GED. Bachelor’s degree in healthcare administration, business administration, or a related field is preferred.  Prior experience in the healthcare environment and/or customer service is preferred. This position requires certification through Medicaid as an Application Assister and to award HPE.  A working knowledge of computers and systems to include Microsoft Word, Excel, and Outlook are necessary.  This position requires the ability to communicate in a pleasant, professional, concise, and caring manner. It also requires critical thinking and problem solving to ensure the best care possible for our patients.  Bi-lingual is preferred.

About Us

Lake Guntersville, a mountain-lakes jewel, is located approximately 30 miles from metro Huntsville – and is home to Marshall Medical Centers.

Marshall Medical Centers, an affiliate of the Huntsville Hospital Health System, serves the residents of Marshall County and the surrounding area (population approximately 125,000). With two hospitals, eight outpatient locations and a highly-trained team of physicians practicing 28 specialties, Marshall Medical is a confident, convenient choice for local healthcare. Residents can remain close to home and receive excellent care – often provided by those who are neighbors and friends.

Marshall Medical Center South is a 150-bed hospital in Boaz, Alabama, and opened in 1956. Marshall Medical Center North, in Guntersville, opened in 1990 – and – is a 90-bed facility. In addition to the two hospitals, the Gary R. Gore Medical Complex is conveniently located mid-county and is home to several outpatient clinics and a 22,000 square foot comprehensive Cancer Care Center.

Named by the Joint Commission as a “Top Quality Performer” among America’s hospitals, Marshall Medical Centers’ patients can be assured they are being treated in an environment where a premium is placed on quality and best practices.