About this role
Lead insurance verification and benefits workflows while helping evaluate AI tools that automate front-end healthcare revenue cycle operations. Your expertise in payer systems, EDI transactions, and eligibility processes will help improve the accuracy and efficiency of insurance verification.
Key Responsibilities- Oversee insurance verification, eligibility determination, and benefits investigation across commercial, Medicare, Medicaid, and managed care payers.
- Verify coverage through payer portals, clearinghouses, and real-time EDI 270/271 eligibility transactions.
- Resolve coordination of benefits issues, coverage gaps, and eligibility discrepancies before services are delivered.
- Review and annotate AI-generated eligibility verification results for accuracy, completeness, and payer compliance.
- Create and maintain standard operating procedures for eligibility and benefits verification workflows.
- Track verification accuracy, eligibility-related front-end denial rates, and turnaround times.
- Maintain compliance with payer-specific requirements, CMS guidance, and HIPAA regulations.
- Identify process gaps and recommend improvements that reduce eligibility-related claim denials.
- Provide structured feedback and annotations that support AI training datasets.
- At least 5 years of experience in insurance verification, eligibility and benefits management, or front-end revenue cycle operations, including at least 2 years in a management role.
- Expert knowledge of EDI 270/271 transactions, payer portal navigation, and real-time eligibility tools.
- Strong knowledge of Medicare, Medicaid, and commercial payer eligibility requirements and benefit structures.
- Proficiency with Epic, Cerner, Meditech, or a comparable EHR platform.
- Experience with clearinghouse platforms such as Availity, Change Healthcare, or similar tools.
- Excellent written and verbal English communication skills.
- Strong attention to detail and the ability to detect subtle coverage-data discrepancies.
- CHAM, CHAA, or an equivalent front-end revenue cycle certification.
- Experience with automated eligibility verification tools and RPA solutions.
- Experience analyzing denial root causes related to eligibility or coverage errors.
- Familiarity with AI tools and comfort evaluating AI-generated healthcare content.
- Experience presenting eligibility performance data to senior leadership.
- Remote, hourly engagement.
- $105 per hour.
- Contribute to advanced AI work in healthcare, collaborating on AI workflows for revenue cycle management and projects that shape healthcare AI.