Billing Operations Manager – Eligibility/ Verification Authorization

Role Summary

Billing Operations Manager to lead and manage the Eligibility function within the Billing Operations team. Responsible for overseeing the daily operations of the Eligibility team and ensuring timely and accurate verification of patient benefits. Supports revenue cycle efficiency and patient access by ensuring insurance eligibility processes are compliant, efficient, and patient-focused. Provides leadership, training, and performance management to staff, while partnering cross-functionally to optimize workflows and resolve payer issues.

Responsibilities

• Lead and manage the Eligibility team, ensuring accurate and timely insurance verification, prior authorizations, and benefit assessments.
• Develop and monitor team performance metrics, ensuring goals are met for turnaround time, accuracy, and payer compliance.
• Collaborate with payers to resolve eligibility discrepancies, denials, and escalations.
• Work closely with Revenue Cycle leadership to identify trends, gaps, and opportunities for process improvements.
• Implement and update policies and procedures to ensure compliance with regulatory and payer requirements.
• Train, coach, and mentor team members to enhance knowledge of payer guidelines, systems, and best practices.
• Partner with cross-functional teams Billing to support a seamless patient and provider experience.
• Provide regular reporting and analysis of eligibility performance, including KPIs, denial trends, and payer turnaround times.
• Manage staffing schedules, workload distribution, and productivity standards to ensure operational coverage and efficiency.
• Support system implementations, testing, and enhancements related to eligibility processes.
• Provide strategic direction, coaching, and professional development to foster a high-performance culture.
• Lead by example and promote a culture of accountability and continuous improvement.
• Identify and implement process enhancements to improve efficiency, reduce error rates, and support scalability.
• Standardize procedures and documentation across the department.
• Evaluate and implement technology solutions and reporting tools to support automation and performance tracking.
• Ensure adherence to HIPAA, payer rules, and all relevant state and federal regulations.
• Stay current on industry best practices, regulatory updates, and payer changes impacting billing and date of service requirements.

Qualifications

• High School diploma or equivalent required
• 5–7 years of experience in healthcare billing operations, with at least 2–3 years in a supervisory or management role
• Strong knowledge of CPT, ICD-10, HCPCS coding, payer regulations, and revenue cycle management
• Ability to lead cross-functional initiatives and manage timelines, resources, and deliverables
• Experience with Medicare Advantage plans and familiarity with Xifin is a plus
• Demonstrated ability to lead teams, manage change, and drive performance in a fast-paced environment
• Proficiency in Microsoft Office Suite (Excel, Word, Outlook, Access) and healthcare billing systems
• Strong interpersonal, communication, and problem-solving skills

Preferred Qualifications

• Bachelor’s degree in Business, Healthcare Administration, or related field
• Familiarity with lab workflows and integration with billing systems
• Experience with Data Analytics Tools
• Ability to navigate diverse payer requirements and regulatory environments
• Proven ability to lead teams through organizational or system transitions
• Experience in Precision Medicine or Oncology Billing
• Focus on service, quality, and continuous improvement
• Ability to analyze complex issues and develop effective solutions
• Work effectively across departments to achieve shared goals
• Understand and exceed internal and external client expectations
• Thrive in a dynamic environment with evolving priorities

Physical Demands

• Ability to sit and/or stand for extended periods
• Perform repetitive motions and lift up to 15 pounds
• Majority of work performed in a desk/cubicle environment

Training

• All job specific, safety, and compliance training are assigned based on the job functions associated with this employee

Other

• This position may require some evenings, weekends and/or holidays