Job Description

The Eligibility & Benefits Supervisor provides leadership, oversight, and continuous improvement for the organization’s Eligibility and Benefits Team, including BH Eligibility Specialists, IDD Eligibility Specialists, Medicaid Spenddown Specialists, and Medicaid Outreach Coordinators. The position ensures individuals maintain access to Medicaid and other available benefits while minimizing coverage interruptions, procedural disenrollment, and barriers to care.

The Supervisor oversees Medicaid eligibility, renewals, reinstatements, spenddown, outreach, SSI/SSDI assistance, and related benefit functions. This position monitors team performance, develops standardized workflows, ensures compliance, and partners with clinical, administrative, finance, and revenue cycle teams to support access to care and financial sustainability.

1. Supervise, coach, train, and evaluate BH Eligibility Specialists, Medicaid Eligibility Specialists, Medicaid Spenddown Specialists, Medicaid Outreach Coordinators, and other assigned staff.
2. Establish staff assignments, caseloads, productivity expectations, and performance goals based on workload, renewal volume, and population complexity.
3. Oversee Medicaid applications, renewals, redeterminations, spenddown requirements, reinstatements, and coverage continuity activities.
4. Oversee assistance with Healthy Michigan Plan, SSI/SSDI, patient assistance programs, and other applicable benefit programs.
5. Develop, implement, and maintain standardized eligibility, spenddown, outreach, documentation, and escalation procedures.
6. Monitor upcoming renewal deadlines and high-risk cases to prevent procedural disenrollment, coverage gaps, and interruptions in services.
7. Serve as the escalation resource for complex eligibility, spenddown, benefit, denial, and reinstatement issues.
8. Oversee outreach campaigns and evaluate contact rates, renewal completion, individual engagement, and coverage recovery outcomes.
9. Monitor staff caseloads, productivity, documentation accuracy, timeliness, and compliance with established performance standards.
10. Conduct quality reviews and audits of eligibility files, spenddown records, outreach activities, and supporting documentation.
11. Ensure compliance with Medicaid regulations, MDHHS requirements, HIPAA, organizational policies, and confidentiality standards.
12. Analyze eligibility, renewal, spenddown, outreach, reinstatement, and procedural disenrollment data to identify trends and recommend improvements.
13. Prepare and present operational reports, key performance indicators, staffing recommendations, and coverage continuity outcomes to leadership.
14. Collaborate with clinical teams, care management, Revenue Cycle Management, Finance, MDHHS, the Social Security Administration, and community partners.
15. Maintain current knowledge of Medicaid and public-benefit requirements, communicate policy changes to staff, and lead related training and process improvements.