Insurance Verification & Benefit Manager

Role Overview

This contract position focuses on leveraging advanced front-end revenue cycle expertise to assess and enhance automated eligibility verification systems. The role bridges payer operations and healthcare automation, significantly influencing large-scale eligibility workflow construction and validation.

Key Duties

• Manage comprehensive insurance verification, eligibility assessment, and benefits investigation for commercial, Medicare, Medicaid, and managed care payers, targeting reduction of front-end denials.
• Perform and confirm real-time eligibility checks via EDI 270/271, payer web portals, and clearinghouse platforms, resolving conflicts in coordination of benefits and coverage discrepancies before services are provided.
• Analyze and annotate outputs from large language model-generated eligibility verification to ensure accuracy, completeness, and compliance with payer standards, feeding structured feedback to improve model training datasets.
• Create and update standard operating procedures (SOPs) for eligibility and benefits verification aligned with CMS guidance, payer-specific protocols, and HIPAA requirements.
• Track and communicate key performance indicators (KPIs) such as verification accuracy, eligibility-related denials, and turnaround times to senior leadership.
• Spot systemic inefficiencies and suggest workflow enhancements to minimize eligibility-related claim denials throughout the revenue cycle.

Required Qualifications

• In-depth knowledge of EDI 270/271 transactions, real-time eligibility platforms, and payer portal navigation across commercial, Medicare, and Medicaid benefits.
• Proven leadership experience managing front-end revenue cycle operations including supervision of verification workflows and team outcomes.
• Experienced user of Epic, Cerner, Meditech, or comparable electronic health record systems in high-volume eligibility settings.
• Hands-on familiarity with clearinghouse tools like Availity or Change Healthcare.
• Strong capability to detect nuanced discrepancies in insurance coverage and eligibility information with high accuracy.
• Excellent written communication skill, enabling clear annotation, SOP composition, and detailed performance reporting.

Additional Advantages

• Preferred credentials include CHAM, CHAA, or similar front-end revenue cycle certifications.
• Experience performing root cause analyses of denials related to eligibility and coverage errors.
• Past involvement with Robotic Process Automation (RPA) or automated eligibility verification technologies in healthcare.

Compensation and Work Conditions

Hourly pay of $105 with flexible scheduling, fully remote work arrangement.