- 経験
- 5年以上
- 給料
- USD 105 – USD 105 / hour
- 求人情報
- 1
- 投稿済み
- 2週間前
- 作業モード
- 在任中
- 資格
- Professionals with a background in insurance verification, eligibility and benefits management, or front-end revenue cycle operations, especially those with management experience, are suitable for this role.
- 再開する
- 応募必須
勤務地
仕事内容
Overview
Great Value Hiring is looking for an Insurance Verification & Benefit Manager to help assess AI-driven tools built to streamline front-end revenue cycle processes.
What the role involves
- Lead the end-to-end workflow for insurance verification, eligibility checks, and benefits review across commercial, Medicare, Medicaid, and managed care plans.
- Confirm patient coverage through payer websites, clearinghouses, and EDI 270/271 live eligibility transactions.
- Spot and correct coordination-of-benefits problems, coverage interruptions, and eligibility mismatches before services are delivered.
- Review AI-produced eligibility outputs, checking them for completeness, correctness, and payer-rule alignment.
- Create and maintain SOPs for eligibility and benefits verification processes.
- Track operational metrics such as verification accuracy, front-end denial rates tied to eligibility, and turnaround time.
- Maintain adherence to payer-specific rules, CMS requirements, and HIPAA standards.
- Find workflow bottlenecks and suggest changes that can lower eligibility-related claim denials.
- Deliver structured notes and feedback to support AI model training data.
Requirements
- At least 5 years of experience in insurance verification, eligibility and benefits management, or front-end revenue cycle operations, including a minimum of 2 years in a management position.
- Deep working knowledge of EDI 270/271 transactions, payer portal workflows, and real-time eligibility systems.
- Strong understanding of Medicare, Medicaid, and commercial payer rules and benefit design.
- Hands-on experience with EHR systems such as Epic, Cerner, Meditech, or similar platforms.
- Prior exposure to clearinghouse tools like Availity, Change Healthcare, or comparable systems.
- Excellent written and spoken English communication skills.
- Sharp attention to detail and the ability to catch small inconsistencies in coverage information.
Nice to have
- CHAM, CHAA, or an equivalent front-end revenue cycle certification.
- Experience working with automated eligibility verification tools or RPA-based solutions.
- Background in analyzing the root cause of denials linked to eligibility and coverage issues.
- Comfort evaluating AI-generated healthcare content and using AI tools in workflow assessment.
- Experience presenting eligibility performance metrics to senior stakeholders.
Compensation
Pay is listed at $105 per hour.