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Prime Healthcare · 2 days ago

Eligibility Services Manager

DFW Metroplex

Full-time

Onsite

Senior Level

5+ years exp

Prime Healthcare is an award-winning health system headquartered in Ontario, California, seeking an Eligibility Services Manager to oversee and manage the Medicaid enrollment and eligibility process for patients. This role involves leading a team, ensuring compliance with regulations, and optimizing enrollment outcomes to support organizational financial goals.

Health CareHospital

Responsibilities

Lead, train, and supervise Medicaid eligibility staff to ensure accurate and efficient enrollment of patients

Oversee the daily operations of the Medicaid eligibility and enrollment process, including application submissions, follow-ups, and approvals

Develop and maintain policies and procedures that ensure compliance with federal, state, and local Medicaid regulations

Screen Patients for financial aid and SSI

Monitor and report on Medicaid enrollment metrics, patient conversion rates, and financial impact

Partner with case management, social work, patient financial services, and clinical teams to identify eligible patients early in the care process

Act as a liaison between the hospital, state Medicaid offices, and external vendors to resolve application or eligibility issues

Stay current with changes in Medicaid rules, eligibility criteria, and healthcare policies; communicate updates to staff and leadership

Provide ongoing staff training and education to maintain high-quality service and compliance

Ensure the department meets or exceeds key performance indicators (KPIs) related to patient enrollment and financial recovery

Support patients and families with compassion and professionalism, ensuring they understand the eligibility process and available options

Qualification

Medicaid EligibilityPatient AdvocacyPolicy DevelopmentTeam LeadershipStaff Training

Required

5+ years experience in Patient Advocacy/Medicaid Eligibility & Enrollment

Preferred

Bachelor Degree preferred

Company

Prime Healthcare

Glassdoor3.0

About Prime Healthcare and Prime Healthcare Foundation: Prime Healthcare is an award-winning health system operating 51 hospitals and more than 360 outpatient locations in 14 states, providing over 2.5 million patient visits annually.

Founded in 2001

Ontario, California, USA

10001+ employees