We are looking for Insurance Verification & Benefit Manager candidates for a project delivered through Mercor.
What you'll do
- 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.
- Ensure compliance with payer-specific requirements, CMS guidelines, and HIPAA regulations.
- Identify process gaps and recommend workflow improvements to reduce eligibility-related claim denials.
- Provide structured feedback and annotations to support AI training datasets.
What you need
- 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.
Nice to have
- 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.
Expertise
Who you work with
Project and contracting process: Mercor. Applications continue on the provider's website.