Eligibility & Benefits Manager - Remote | Upto $105/hr
关于工作的职位，默科尔将精英创意和技术人才与领先的人工智能研究实验室联系起来。总部位于旧金山，我们的投资者包括 Benchmark,General Catalyst,Peter Thiel,Adam D'Angelo,Larry Summers 和 Jack Dorsey.职位：保险验证和福利经理类型：合同补偿：105美元/小时地点：远程角色责任 ·监督在商业，医疗保健，医疗救助和付费者管理服务领域的保险验證，合格确定以及福利调查的工作流程。·通过门户，清算房和 EDI 270/271实时符合性交易来验证患者保险覆盖。· 在提供服务之前确定和解决福利问题，覆盖差距和资格不一致性。·评估并注释人工智能生成的资格验证输出以查看准确度，完整性和付款人遵守情况。·制定和记录资格和福利验证工作流程的 SOP. ·监测包括验证精度率，与资格相关的前端拒绝率和转换时间等 KPI. ·确保符合付款人特定要求，CMS 指导方针和 HIPAA 规定。·识别过程缺陷并建议改进工作流程以减少资格相关的主张拒绝。· 提供结构化反和注释，以支持人工智能培训数据集。资格必须有5年以上在保险验证，资格和福利管理或前端收入周期运营方面的经验，至少2年担任管理职位。· 对 EDI 270/271交易的专家知识，支付人门户网站导航以及实时资格工具。·对医疗保险，医疗补助和商业支付人的资格要求和福利结构的强烈熟悉。·与 Epic,Cerner,Meditech 或同等 EHR 平台的熟练知识。· 与 Availity,Change Healthcare 等清算室平台或类似的经验。· 特殊的书面和口头英语沟通技能。·高度关注细节，能够识别覆盖数据中的微妙差异。优先 • CHAM,CHAA 或相等前端收入周期认证。· 自动资格验证工具和 RPA 解决方案的经验。·与资格和覆盖错误有关的拒绝根源分析背景。·熟悉人工智能工具和评估人工智能生成的医疗保健内容的舒适性。· 提供资格的经验
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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.
- 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.
Qualifications
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.
Preferred
- 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.
Application Process (Takes 20–30 mins to complete)
- Upload resume
- AI interview based on your resume
- Submit form
Resources & Support
- For details about the interview process and platform information, please check:
- For any help or support, reach out to:
PS: Our team reviews applications daily. Please complete your AI interview and application steps to be considered for this opportunity.
Originally posted on Himalayas