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Eligibility Manager Jobs in Ohio (NOW HIRING)

Miami County

Eligibility Referral Specialist I

Troy, OH · On-site

$19.60/hr

CLASSIFICATION PURPOSE The purpose of the Eligibility Referral Specialist is to interview and ... Case Management and Employment Program (CCMEP), and other programs. JOB DUTIES Interviews and ...

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Eligibility Manager information

What is an eligibility manager?

An Eligibility Manager is a professional responsible for overseeing and managing the process of determining if individuals or groups qualify for specific programs, benefits, or services. They typically work for government agencies, healthcare organizations, or insurance companies. Their duties include supervising eligibility staff, ensuring compliance with policies and regulations, and resolving complex eligibility determinations or appeals. Eligibility Managers play a crucial role in making sure that assistance is provided to those who meet the necessary requirements, while preventing fraud and misuse of resources.

What are the key skills and qualifications needed to thrive as an eligibility manager, and why are they important?

To thrive as an Eligibility Manager, you need expertise in eligibility determination, compliance regulations, and case management, often supported by a bachelor's degree in social work, public administration, or a related field. Familiarity with eligibility management systems, case tracking software, and knowledge of relevant federal and state regulations is typically required. Strong leadership, problem-solving, and communication skills help in managing teams and resolving complex eligibility cases. These competencies are vital for ensuring accurate eligibility determinations, regulatory compliance, and efficient program operations.

What are the most common challenges faced by an eligibility manager in ensuring compliance with changing regulations?

Eligibility Managers often encounter challenges related to staying up-to-date with frequently changing federal, state, and local regulations that impact program eligibility criteria. They must ensure that their team is properly trained on new policies and that all documentation and procedures remain compliant. Additionally, balancing high caseloads while maintaining accuracy and timeliness in processing applications can be demanding. Effective communication with both applicants and internal departments is crucial to navigate complex cases and resolve discrepancies efficiently.

What is the difference between Eligibility Manager vs Claims Specialist?

CriteriaEligibility ManagerClaims Specialist
Required credentialsTypically requires a high school diploma or associate degree; certifications like Certified Eligibility Specialist are commonUsually requires a high school diploma; certifications like Certified Claims Professional are beneficial
Work environmentOffice setting, healthcare or insurance companiesOffice setting, healthcare or insurance companies
Employer and industry usageUsed in healthcare, insurance, government agenciesUsed in healthcare, insurance, and related sectors
Common search and comparison intentUnderstanding roles, responsibilities, and qualificationsUnderstanding differences in claims processing and eligibility

Eligibility Managers focus on verifying patient or client eligibility for services or benefits, ensuring compliance with policies. Claims Specialists handle processing and adjudicating insurance claims, focusing on reimbursement and accuracy. While both roles operate within healthcare and insurance sectors, Eligibility Managers primarily verify eligibility, whereas Claims Specialists manage claims processing.

What are the most commonly searched types of Eligibility jobs in Ohio?

The most popular types of Eligibility jobs in Ohio are:

What are popular job titles related to Eligibility Manager jobs in Ohio?

For Eligibility Manager jobs in Ohio, the most frequently searched job titles are:

What cities in Ohio are hiring for Eligibility Manager jobs?

Cities in Ohio with the most Eligibility Manager job openings:

Eligibility Manager jobs near you
Infographic showing various Eligibility Manager job openings in Ohio as of August 2026, with employment types broken down into 100% Full Time. Highlights an 74% In-person, and 26% Remote job distribution.

Supervisor (Eligibility)

Elevate Patient Financial Solutions

Cincinnati, OH • On-site

$50K - $75K/yr

Full-time

Medical, Dental, Vision, Retirement, PTO

Re-posted 21 days ago

Elevate Patient Financial Solutions rating

7.9

Company rating: 7.9 out of 10

Based on 28 frontline employees who took The Breakroom Quiz

Job description

Make a real difference in patients' lives-join Elevate Patient Financial Solutions as an Eligibility Supervisor and help guide individuals through their healthcare financial journey. This full-time position is located 100% onsite at a hospital in Cincinnati, Ohio with a Monday-Friday schedule from 8:00 AM to 4:30 PM.
Bring your passion for helping others and grow with a company that values your impact. In 2024, our Eligibility division helped over 823,000 patients secure the Medicaid coverage they needed. Elevate's mission is to make a difference. Are you ready to be the difference?
As an Eligibility Supervisor, you play a vital role in supporting a team that guides uninsured hospital patients through the complex landscape of medical and disability assistance. While your team provides compassionate, face-to-face support to patients during some of life's most vulnerable moments, you help ensure the day-to-day operations that support this mission are handled with care and consistency.
In this onsite, hospital-based role, you are responsible for overseeing timecard accuracy, conducting internal audits to maintain compliance, and leading new hire training to ensure advocates are well-prepared and aligned with program standards. You also serve as a resource for complex or escalated cases-offering guidance, troubleshooting challenges, and ensuring patients receive the highest level of advocacy and support.
Additionally, you act as a critical bridge between patient-facing staff and upper-level management-communicating needs, sharing feedback, and helping align team efforts with broader organizational goals. Your attention to detail and problem-solving skills help uphold the integrity of the patient financial advocacy process-ensuring every Advocate is equipped to make a meaningful impact.
Essential Duties and Responsibilities
  • Supervise and orient employees; assign work, develop work schedules, instruct in proper procedures; assist with development and revision of department processes/procedures
  • Manage employee performance and provide feedback
  • Ensures staff is obtaining adequate information; provides opportunity for associated training for staff.
  • Responsible for running reports and maintaining data integrity
  • Monitor billing procedures and documentation, and provides updates with regulatory compliance; conducts periodic audits, and maintains files.
  • Develop relationships with clients and county, state and government agencies.
  • Manage employee time and attendance
  • Other duties as assigned.

Qualifications and Requirements
To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or abilities.
  • High School Diploma or GED
  • Minimum of 2 years of experience managing or supervising employees preferred
  • Familiarization for the following programs is required: Medicaid and Out of State Medicaid.
  • Strong oral and written communication
  • Excellent people skills
  • Strong Computer knowledge especially Excel.
  • Familiarity with Epic preferred
  • Remote and Hybrid positions require a home internet connection that meets the company's upload and download speed criteria.

Benefits
ElevatePFS believes in making a positive impact not only within our industry but also with our employees -the organization's greatest asset! We take pride in offering comprehensive benefits in a vast array of plans that contribute to the present and future well-being of our employees and their families.
  • Medical, Dental & Vision Insurance
  • 401K (100% match for the first 3% & 50% match for the next 2%)
  • 15 days of PTO
  • 7 paid Holidays
  • 2 Floating holidays
  • 1 Elevate Day (floating holiday)
  • Pet Insurance
  • Employee referral bonus program
  • Teamwork: We believe in teamwork and having fun together
  • Career Growth: Gain great experience to promote to higher roles

The salary of the finalist selected for this role will be set based on a variety of factors, including but not limited to, internal equity, experience, education, location, specialty and training. This pay scale is not a promise of a particular wage.
The job description does not constitute an employment agreement between the employer and Employee and is subject to change by the employer as the needs of the employer and requirements of the job change.
ElevatePFS is an Equal Opportunity Employer
Pay Range: $50,000 - $75,375 per year

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