Manager, Revenue Cycle Management – Eligibility

Location: Powell, Ohio
Employment Type: Full-Time
Reports To: Director of Revenue Cycle Management

About Us

At Solvedge Inc, we develop and deliver cutting-edge healthcare software solutions and services tailored to hospitals, clinics, and private practices across the United States. We enable healthcare organizations to improve operational efficiency, enhance patient outcomes, and ensure compliance with regulatory standards. As we continue to grow, we are seeking a results-driven Manager, Revenue Cycle Management – Eligibility to lead and evolve our eligibility operations, ensuring accuracy, compliance, and process excellence within our revenue cycle framework.

Position Overview

The Manager, Revenue Cycle Management – Eligibility is responsible for overseeing all aspects of the insurance eligibility process, including payer verification, benefits interpretation, and out-of-pocket estimation. This role plays a critical leadership function in driving team performance, enhancing operational workflows, and ensuring regulatory and payer compliance. The ideal candidate will be proactive, detail-oriented, and capable of fostering a high-performing team in a fast-paced healthcare technology environment.

Key Responsibilities

Operational Management

• Lead all day-to-day functions of the eligibility team to ensure timely and accurate insurance verification and benefit validation.
• Develop and implement standardized workflows aimed at improving productivity, reducing denials, and ensuring high-quality outputs.
• Monitor and report key performance indicators (KPIs) and operational metrics to senior leadership, with a focus on continuous process improvement.

Team Leadership and Development

• Drive recruitment, onboarding, training, and ongoing coaching of team members to foster engagement and accountability.
• Conduct performance evaluations, set clear objectives, and promote a culture of excellence and compliance.

Compliance and Quality Assurance

• Ensure strict adherence to payer requirements, HIPAA standards, and applicable healthcare industry regulations.
• Conduct periodic audits of eligibility activities to identify process gaps, address deficiencies, and support corrective actions.

Collaboration and Communication

• Collaborate with internal stakeholders (revenue cycle, clinical operations, product, and support teams) to resolve complex eligibility issues and improve patient access workflows.
• Liaise with external vendors and payer representatives to address challenges and maintain streamlined operations.

Process Improvement and Training

• Perform root cause analysis and develop mitigation strategies for frequent eligibility-related denials and access issues.
• Maintain comprehensive and up-to-date documentation, including SOPs, workflow diagrams, and internal/external training guides.
• Create visual, easy-to-understand training materials using tools such as Visio, Lucidchart, Canva, or Figma to support learning and operational clarity.

Skills and Competencies

• Strong understanding of healthcare payer guidelines, insurance verification procedures, and reimbursement methodologies.
• Excellent verbal and written communication skills, with the ability to simplify complex eligibility or insurance-related topics for diverse audiences.
• Proficiency in Microsoft Office Suite and workflow/design tools such as Visio, Canva, Lucidchart, Miro, or Figma.
• Proven ability to lead and develop teams while fostering collaboration and accountability.
• Analytical, metrics-driven, and process-oriented mindset with strong organizational skills.
• Adaptable to dynamic, high-growth environments with cross-functional dependencies.

Education

• Bachelor’s degree in healthcare administration, business, or related field preferred.
• Equivalent combination of education and experience will be considered.

Experience

• Minimum of 5 years of experience in Revenue Cycle Management, with deep expertise in eligibility verification, prior authorization, or benefits coordination.
• 5–7 years of experience in a healthcare, clinical, or diagnostic laboratory setting preferred.
• Experience in developing and maintaining training documents, job aids, and SOPs required.
• Leadership experience in managing teams and/or training functions highly preferred.

Why Solvedge?

• Join a rapidly growing, mission-driven company dedicated to transforming healthcare delivery through technology.
• Collaborative, inclusive work culture that values innovation, transparency, and professional development.
• Competitive compensation and benefits package including health coverage, performance incentives, and wellness initiatives.
• Opportunities for growth, leadership, and contribution to meaningful healthcare transformation.

To Apply:
Submit your resume and a cover letter outlining your qualifications and interest in this opportunity to hrindia@solvedge.com