AI Summary
Verify patient insurance coverage, resolve coordination of benefits issues, and evaluate AI-generated eligibility verification outputs. 5+ years of experience in insurance verification, eligibility and benefits management required. Strong familiarity with Medicare, Medicaid, and commercial payer eligibility requirements.
Key Highlights
Verify patient insurance coverage
Resolve coordination of benefits issues
Evaluate AI-generated eligibility verification outputs
Key Responsibilities
Oversee insurance verification, eligibility determination, and benefits investigation workflows
Verify patient insurance coverage using payer portals, clearinghouses, and EDI 270/271 real-time eligibility transactions
Evaluate and annotate AI-generated eligibility verification outputs for accuracy, completeness, and payer compliance
Technical Skills Required
Benefits & Perks
$105/hour
Remote work
Nice to Have
CHAM, CHAA, or equivalent front-end revenue cycle certification
Experience with automated eligibility verification tools and RPA solutions
Job Description
About The Job
Mercor connects elite creative and technical talent with leading AI research labs. Headquartered in San Francisco, our investors include Benchmark, General Catalyst, Peter Thiel, Adam D'Angelo, Larry Summers, and Jack Dorsey.
Position: Insurance Verification & Benefit Manager
Type: Contract
Compensation: $105/hour
Location: Remote
Role Responsibilities
- Oversee insurance verification, eligibility determination, and benefits investigation workflows across commercial, Medicare, Medicaid, and managed care payers.
- Verify patient insurance coverage using payer portals, clearinghouses, and EDI 270/271 real-time eligibility transactions.
- Identify and resolve coordination of benefits issues, coverage gaps, and eligibility discrepancies prior to service delivery.
- Evaluate and annotate AI-generated eligibility verification outputs for accuracy, completeness, and payer compliance.
- Develop and document SOPs for eligibility and benefits verification workflows.
- Monitor KPIs including verification accuracy rates, front-end denial rates related to eligibility, and turnaround times.
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Must-Have
- 5+ years of experience in insurance verification, eligibility and benefits management, or front-end revenue cycle operations, with at least 2 years in a management role.
- Expert knowledge of EDI 270/271 transactions, payer portal navigation, and real-time eligibility tools.
- Strong familiarity with Medicare, Medicaid, and commercial payer eligibility requirements and benefit structures.
- Proficiency with Epic, Cerner, Meditech, or equivalent EHR platforms.
- Experience with clearinghouse platforms such as Availity, Change Healthcare, or similar.
- Exceptional written and verbal English communication skills.
- High attention to detail with the ability to identify subtle discrepancies in coverage data.
- CHAM, CHAA, or equivalent front-end revenue cycle certification.
- Experience with automated eligibility verification tools and RPA solutions.
- Background in denial root cause analysis related to eligibility and coverage errors.
- Familiarity with AI tools and comfort evaluating AI-generated healthcare content.
- Experience presenting eligibility performance data to senior leadership.
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- For details about the interview process and platform information, please check: https://talent.docs.mercor.com/welcome
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