Director of Client Eligibility

Company: Lee Hecht Harrison Nederland B.V.
Location: Mesa
Posted on: October 8, 2024

Job Description:

As the Director of Client Eligibility, you will spearhead the planning, development, and implementation of all eligibility and enrollment processes across the organization. In this strategic leadership role, you will directly influence access to essential health services by ensuring the smooth administration of eligibility functions and compliance with state, federal, and payer-specific regulations. You will work cross-functionally with departments to drive operational efficiency and optimize enrollment systems, with a particular focus on behavioral health services and physical healthcare.Applicants must reside in Arizona.Responsibilities:

• Manages eligibility, benefits, and coverage determination strategies across multiple states (AZ, UT, DC, OK). Develop strategic initiatives to address state-by-state variations in benefits and payer requirements.
• Knowledge of Medicare, Medicaid, Tricare, commercial insurance, and federal funding mechanisms to manage payer relations and ensure compliance with payer contracts. Recommend process improvements for managing discrepancies across payers.
• Use data analytics tools (Power BI, Excel) to identify trends in population data, discrepancies in coverage, and opportunities for improved payer relations and business growth.
• Supervise a team of enrollment specialists, guiding them in managing enrollment, eligibility, and benefit processes, including resolving issues with payers and tracking enrollment trends.
• Ensure daily compliance reporting for individuals lacking appropriate coverage. Work closely with inpatient and outpatient leadership, claims, IT, and payers to ensure benefits and eligibility are managed in line with regulatory standards (CFR, AAC).
• Develop and oversee internal audits and controls to minimize discrepancies, ensuring payers are updated on changes, and maintaining proper enrollment processes.
• Collaborate with departments such as Utilization Review (UR), Billing, Contracting, and IT to streamline communication and improve cross-functional operations.Qualifications:
  • Bachelor's degree in behavioral health, healthcare administration, or a related field (Master's degree preferred).
  • A minimum of 3 years of behavioral health experience, particularly in eligibility verification, benefit management, and enrollment.
  • A minimum of 5 years of progressive management experience, ideally within the behavioral health industry.
  • In-depth knowledge of Medicaid, commercial insurance, and public healthcare systems.
  • Expertise in navigating complex regulations, including CPT, HCPC, and Revenue Codes.
  • Ability to access and interpret benefits for various healthcare funding streams (e.g., Medicaid, SUBG, MHBG, SOR).Benefits package:
    • Generous PTO accrual (5 weeks!).
    • Medical, Dental, Vision, Disability, Life, Supplemental plans.
    • Hospital indemnity/ Critical Illness.
    • Pet Insurance.
    • Dependent Care Savings, Health Care Savings.
    • 401K with employer match - 100% vested upon enrollment.
    • Wellness programs.
    • Tuition Reimbursement and Scholarship Programs, incentives, and more!Pay Details: $80,000.00 to $95,000.00 per yearSearch managed by: Joanna CalderonEqual Opportunity Employer/Veterans/DisabledTo read our Candidate Privacy Information Statement, which explains how we will use your information, please navigate to .The Company will consider qualified applicants with arrest and conviction records in accordance with federal, state, and local laws and/or security clearance requirements, including, as applicable:
      • The California Fair Chance Act
      • Los Angeles City Fair Chance Ordinance
      • Los Angeles County Fair Chance Ordinance for Employers
      • San Francisco Fair Chance Ordinance
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Keywords: Lee Hecht Harrison Nederland B.V., Sun City , Director of Client Eligibility, Executive , Mesa, Arizona