Eligibility Manager
$70,304–$85,000 year
On-siteFresno, California, United States
Job Summary
Lead the Eligibility department within the Finance team, ensuring accurate and timely determination, maintenance, and optimization of participant eligibility and enrollment. Provide strategic direction and supervision to the Eligibility Supervisor and Specialists, managing performance evaluations, coaching, and disciplinary actions. Oversee daily operations, including the review of 820/834 files and transaction reports, while ensuring full compliance with Medi-Cal, Medicare, and PACE regulations. Develop and improve policies for enrollment, disenrollments, and revenue optimization. Serve as the primary escalation point for complex eligibility issues across Intake, Social Work, and Claims departments. Prepare regular reports on eligibility metrics and team performance for senior leadership. Maintain expert-level knowledge of eligibility rules and actively participate in cross-functional initiatives to improve operational efficiency.
Required Qualifications
- Minimum of five (5) years of progressive experience in eligibility, enrollment, or revenue cycle management within a managed care organization
- Minimum of three (3) years of supervisory or managerial experience
- Bachelor's degree in Business Administration, Healthcare Administration, or related field
- Is medically cleared for communicable diseases and has all immunizations up-to-date before engaging in direct participant contact
- Valid California Driver's License
Desired Qualifications
- In-depth knowledge of Medi-Cal and Medicare regulations
- Master's Degree
- Experience, preferably in a PACE or senior care setting
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