Thee Eligibility Department often serves as the initial point of contact with Central Health. The Eligibility Department has team members inside the Central Health Navigation Center, onsite at clinics, and working with special populations out in the field. Each team is responsible for assisting individuals with applying for and enrolling in healthcare coverage.

The Eligibility and Enrollment Manager is responsible for creating a team-based approach to accomplishing department tasks and building a positive culture that supports team members in achieving individual, department, and system-wide goals for the organization.

Under general direction of the Director of Operations, the Eligibility and Enrollment Manager is responsible for dayto- day operational management of the on-site eligibility services program team members, whose primary focus is determining eligibility for Central Health coverage programs through on-site eligiblity interviews and screenings as well as through the processing of applications received on-line (OLA), mail or fax. They will lead multiple eligibility team members, including Eligibility Supervisors, Eligibility and Enrollment Specialists, and Eligibility and Enrollment Associates, in completing their daily tasks and ensuring the responsibilities of the unit are met.

Essential Functions

• Coordinate recruitment, hiring, onboarding, and manage timesheets, 90-day reviews, and annual reviews for all assigned staff.
• Responsible for day-to-day operations of eligibility services program consent with performance standards and ensuring department responsibilities are met. This includes managing team schedules to assure the appropriate onsite coverage is met as well as monitoring back-end access points to assure applications re processed timely.
• Assist with the development and revisions of department Standard Operation Procedures, providing policy clarification, guidance, and consultation when needed.
• Work collaboratively with other Eligibility and Navigation Center units as well as other Central Health departments (specialty Care Services, Revenue Cycle,k Procurement, Joint Tech, Facilities) to ensure Eligibility Services is meeting the needs of the organization and the eligibility team members have the tools they need to be successful.
• Maintain strict confidentiality of protected health information (PHI).
• Assist leadership with annual budget planning, needs assessments, and capacity planning.
• Uphold and ensure compliance and attention to all company polices and procedures as well as the overall mission and values of the organization.
• Identify and resolve problems, develop action plans for process improvement and efficiency.

Knowledge, Skills and Abilities

• Demonstrated knowledge of local, state, and federal health insurance and health care coverage programs 
• Working knowledge of Epic 
• Demonstrated leadership and team-building ability 
• Bilingual (English/Spanish) strongly preferred 
• Excellent verbal and written communication skills 
• Ability to coach, train, and motivate employees to meet performance goals 
• Ability to regularly evaluate employee performance and take appropriate action to ensure consistent service delivery 
• Strong attention to detail and accuracy 
• Ability to evaluate data on operational and administrative processes and suggest and implement changes to improve performance 
• Ability to analyze, interpret and address customer needs 
• Ability to multi-task while working in a fast-paced environment 
• Ability to effectively interact with individuals of diverse backgrounds 
• Ability to remain calm and courteous under pressure and navigate tense situations 
• Proficiency in the use of computers and commonly used software, including Microsoft Office Suite 
• Able to think strategically and identify opportunities for improvement and efficiency

Minimum Education:

High School Diploma or equivalent (higher degree accepted)

Minimum Experience:
3 years of experience working in health care, government, non-profit, or a customer service industry 
2 years experience in a leadership or supervisory role
Experience and knowledge of government health insurance eligibility criteria and the application process