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
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