[Hiring] Insurance Verification Manager @Mercor

Role Description

The Insurance Verification & Benefit Manager will oversee various workflows related to insurance verification and benefits management.

• 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.

Qualifications

• 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.

Requirements

• CHAM, CHAA, or equivalent front-end revenue cycle certification (preferred).
• Experience with automated eligibility verification tools and RPA solutions (preferred).
• Background in denial root cause analysis related to eligibility and coverage errors (preferred).
• Familiarity with AI tools and comfort evaluating AI-generated healthcare content (preferred).
• Experience presenting eligibility performance data to senior leadership (preferred).

Benefits

• Compensation: $105/hour
• Type: Contract
• Location: Remote

Application Process

• Upload resume
• AI interview based on your resume
• Submit form

Resources & Support

• For details about the interview process and platform information, please check: Interview Process Details
• For any help or support, reach out to: [email protected]
• Our team reviews applications daily. Please complete your AI interview and application steps to be considered for this opportunity.