Overview
This is an exempt, on-site role, located at our New Providence CBO location and is part of Prism Vision Group.
Compensation Range: $80,000 - $85,000 (Dependent on Experience)
The Manager, Patient Eligibility provides day-to-day operational leadership for the integrated Patient Eligibility team and supports PRISM Vision Group’s centralized support model by aligning people, workflows, quality, and service expectations across assigned practices or regions. The role reinforces “Strength In Unity,” improved patient care, revenue-cycle optimization, compliance, and successful adoption of operational change through consistent coaching, communication, performance management, and cross-functional partnership.
Responsibilities
Essential Roles and Responsibilities
• Provide centralized, consistent support across assigned practices or regions in alignment with PRISM Vision Group standards, adapting to changing workload and operational priorities.
• Oversee daily Patient Eligibility operations, including benefits investigation, prior authorization, financial advocacy, treatment readiness, work assignment, backlog management, and escalation response.
• Ensure work is completed accurately, timely, and in accordance with payer requirements, departmental policies, regulatory standards, and approved workflows.
• Monitor productivity, quality, look-ahead status, attendance, and workload distribution; use data to identify barriers and take timely corrective action.
• Provide day-to-day leadership, coaching, feedback, performance documentation, and development support to Specialists and Senior Specialists in partnership with the Manager/Director and HR.
• Coordinate staffing coverage, training schedules, acquisition support, go-live assignments, and operational priorities.
• Ensure staff receive timely updates regarding payer policy changes, specialty-drug requirements, system changes, documentation standards, and workflow revisions.
• Oversee onboarding and cross-training, competency validation, supported production, quality monitoring, and training remediation.
• Conduct or assign audits and quality reviews; analyze error and denial trends and implement corrective education and workflow improvements.
• Partner with practices, providers, clinical teams, revenue cycle, IT, operations, vendors, and payers to resolve issues and strengthen end-to-end workflows.
• Lead implementation and stabilization activities for acquisitions, new practices, system deployments, and significant operational changes.
• Develop and maintain SOPs, job aids, escalation pathways, reporting tools, and performance dashboards in partnership with leadership and subject-matter experts.
• Prepare and communicate operational reports, risks, trends, staffing needs, and recommended actions to department leadership.
• Promote a professional, accountable, respectful, and patient-centered team culture.
• Perform other leadership duties and special projects as assigned.
Performance Expectations
• Maintain transparent oversight of workload, backlogs, productivity, quality, training status, and operational risks.
• Ensure regional teams meet leadership-approved service levels for initial review, payer follow-up, treatment readiness, stakeholder response, and backlog management.
• Establish, monitor, and report workflow-specific KPIs, including productivity, quality, turnaround time, look-ahead status, denial trends, and training completion.
• Use regional volume, practice demand, provider mix, and operational complexity to recommend staffing assignments and workload redistribution.
• Address performance and conduct concerns promptly, consistently, and in accordance with HR guidance.
• Meet implementation, acquisition, staffing, and reporting commitments and escalate material risks early.
• Demonstrate sound judgment, confidentiality, fairness, follow-through, and effective communication.
• Drive measurable improvement in timeliness, accuracy, treatment readiness, denial prevention, and stakeholder experience.
Qualifications
Minimum Qualifications
• Bachelor's degree in business, healthcare administration, finance, revenue cycle, or a related field preferred; an associate degree plus substantial relevant leadership experience may be considered.
• At least five years of progressive experience in prior authorization, benefits investigation, patient access, specialty medication, or healthcare revenue cycle.
• At least one year of formal or informal leadership, training, workflow-lead, or supervisory experience.
• Demonstrated proficiency in performance management, operational reporting, workflow improvement, and cross-functional communication.
Preferred Qualifications
• Direct supervisory experience in a multi-site or centralized healthcare environment.
• Ophthalmology/retina, infusion, oncology, specialty pharmacy, or buy-and-bill medication experience.
• Experience supporting acquisitions, implementations, system testing, and distributed or remote teams.
• Relevant certifications such as CRCR, CHAA, CPAR, CPC, Lean/Six Sigma, or a recognized leadership credential are preferred.
Knowledge, Skills, and Abilities
• Working knowledge of benefits investigation, prior authorization, appeals, specialty-medication reimbursement, ICD-10, CPT, and HCPCS/J-code concepts.
• Ability to interpret productivity, quality, backlog, and denial data and convert findings into operational action.
• Strong coaching, conflict-management, change-management, and performance-management skills.
• Ability to prioritize across daily operations, training, projects, acquisitions, and urgent escalations.
• Excellent written, verbal, and presentation skills; ability to communicate effectively with staff, executives, providers, and practice leaders.
• High proficiency with Microsoft Office and the ability to learn and administer healthcare workflow systems and reporting tools.
PRISM Quality & Organizational Alignment
• “Strength In Unity”: Collaborate across Benefits Investigation, Prior Authorization, Financial Advocacy, clinical practices, operations, and regional teams to deliver consistent centralized support.
• Improved Patient Care: Complete eligibility and authorization activities accurately and timely to minimize avoidable treatment delays and improve access to care.
• Centralized Support & Revenue-Cycle Optimization: Identify coverage barriers early, reduce rework, document accurately, and use available financial advocacy resources appropriately.
• Compliance: Protect PHI, follow payer and company requirements, and maintain complete, auditable documentation.
• Successful Change: Adapt to new systems, payer requirements, workflows, acquisitions, and organizational initiatives while helping affiliated practices transition successfully.
• Client and Practice Partnership: Provide responsive, solution-oriented support that enables affiliated physicians and practices to focus on patient care.
Physical and Work Requirements
• Ability to perform prolonged computer-based work and communicate by telephone, video, and electronic messaging.
• Ability to manage multiple priorities and meet time-sensitive operational deadlines.
• Ability to maintain confidentiality and comply with HIPAA, company policy, and applicable regulatory requirements.
• Reasonable accommodations may be provided in accordance with applicable law.
