AI-Driven Eligibility & Benefits Lead

Obsidian; Dallas (TX); On-site; USD 90,000 - 130,000; Full time

Job summary

Mercor is seeking an experienced Insurance Verification and Eligibility & Benefits Manager to drive front-end revenue cycle improvements for payer workflows. You will oversee verification, eligibility, and benefits across Medicare, Medicaid, and commercial payers, and annotate AI outputs for accuracy.

Lead SOP development, monitor KPIs, ensure HIPAA compliance, and partner with AI teams to refine automated eligibility tools.

Qualifications

• 5+ years in insurance verification or front-end revenue cycle operations, with 2+ years in management.
• Expert knowledge of EDI 270/271 and real-time eligibility tools.
• Familiar with Medicare, Medicaid, and commercial payer rules.
• Experience with Epic, Cerner, Meditech or equivalent EHR.
• Experience with clearinghouses like Availity or Change Healthcare.
• Excellent written and verbal English communication.
• Strong attention to detail in coverage data.
• CHAM/CHAA or equivalent certification (preferred).
• Experience with automated eligibility tools and RPA solutions (preferred).
• Experience presenting eligibility performance data to senior leadership (preferred).

Responsibilities

• Oversee verification, eligibility, and benefits workflows across payers.
• Verify coverage via payer portals, clearinghouses, and EDI 270/271.
• Resolve COB issues and eligibility gaps before service.
• Annotate AI outputs for accuracy and payer compliance.
• Develop SOPs for verification workflows.
• Monitor KPIs: verification accuracy, denial rates, turnaround times.
• Ensure HIPAA and CMS compliance.
• Identify gaps and recommend workflow improvements.
• Provide feedback to support AI training datasets.

Skills

Insurance verification

Eligibility management

Payer systems

Attention to detail

English communication

Tools

Epic

Cerner

Meditech

Availity

Change Healthcare

Job description

Mercor is seeking an experienced Insurance Verification and Eligibility & Benefits Manager to drive front-end revenue cycle improvements for payer workflows. You will oversee verification, eligibility, and benefits across Medicare, Medicaid, and commercial payers, and annotate AI outputs for accuracy.

Lead SOP development, monitor KPIs, ensure HIPAA compliance, and partner with AI teams to refine automated eligibility tools.