Manager, Eligibility & Authorizations

Overview

The Benefits Eligibility and Authorizations Manager oversees the insurance verification process within the organization, ensuring accuracy, efficiency, and compliance with industry standards and regulations. They manage a team responsible for verifying patient insurance coverage, obtaining authorizations for services, and resolving insurance-related issues.

• Supervises and leads a team of insurance verification and authorization verification specialists.

• Provides training, guidance, and performance evaluations to team members.

• Fosters a positive and collaborative work environment to maximize team productivity and morale.

• Develops and implements standardized procedures for insurance verification.

• Oversees the verification of patient insurance coverage for medical services.

• Ensures timely verification of insurance benefits and eligibility.

• Coordinates the authorization process for medical procedures and services requiring pre-authorization.

• Communicates with insurance companies to obtain necessary authorizations and resolve authorization-related issues.

• Monitors authorization status to ensure compliance with payer requirements and minimize denials.

• Collaborates with billing and coding teams to resolve insurance-related claim rejections and denials.

• Investigates and address discrepancies in insurance coverage and billing information.

• Implements strategies to minimize claim denials and optimize reimbursement.

• Stays updated on changes in insurance regulations, policies, and procedures.

• Ensures compliance with HIPAA regulations and other relevant healthcare laws.

• Conducts regular audits to assess the accuracy and completeness of insurance verification processes.

• Establishes key performance indicators (KPIs) for insurance verification processes.

• Monitors performance metrics and analyzes trends to identify areas for improvement.

• Generates reports and provides insights to management regarding insurance verification efficiency and effectiveness.

• May perform any additional responsibilities or special projects as required.

• May provide cross-functional support as business needs demand.

• Duties and responsibilities may be subject to change based upon the needs of the department.

• Bachelor’s degree in healthcare administration, business administration, or related field or equivalent experience preferred

• Previous experience in healthcare insurance verification, with at least 4+ years in a managerial or supervisory role preferred

• Expertise in insurance verification software and electronic health record (EHR) systems.

• Knowledge of medical insurance terminology, billing practices, and reimbursement processes.

• Familiarity with regulatory requirements, such as HIPAA, and industry best practices in insurance verification.

• Friendly, professional, and effective communications skills; able to calmly present solutions in challenging situations.

• Proactive identification of challenges, and solution-oriented approach to problem solving.

• Service-orientation and aptitude to utilize proper listening skills.

• Effective analytical skills: able to use inductive and deductive reasoning to anticipate outcomes.

• Self-directed accountability and reliability

• Effective leadership, communication, and interpersonal skills, with the ability to influence and collaborate effectively with cross-functional teams.

• Able to manage and prioritize multiple tasks/projects, work autonomously, and meet deadlines.

• Able to work well in a team environment that promotes inclusiveness and communication among team members.

• Communication using both verbal and written English proficiency.

• Cultural competence

Anticipated salary range: $87,700 - $125,000 per year

Bonus eligible: No

Benefits: Cardinal Health offers a wide variety of benefits and programs to support health and well-being.

• Medical, dental and vision coverage

• Paid time off plan

• Health savings account (HSA)

• 401k savings plan

• Access to wages before pay day with myFlex Pay

• Flexible spending accounts (FSAs)

• Short- and long-term disability coverage

• Work-Life resources

• Paid parental leave

• Healthy lifestyle programs

Application window anticipated to close: 10/25/2025…