AI-Driven Eligibility & Benefits Manager

Mercor; Dallas (TX); On-site; USD 110,000 - 160,000; Full time

Job summary

Mercor is partnering with a leading AI research lab to advance front-end revenue cycle automation. We are seeking an experienced Insurance Verification and Eligibility & Benefits Manager to oversee workflows across commercial, Medicare, Medicaid, and managed care payers.

You will verify coverage via payer portals and real-time eligibility tools, annotate AI outputs, develop SOPs, and monitor KPIs while ensuring HIPAA compliance.

Qualifications

• 5+ years in insurance verification, eligibility & benefits management or front-end revenue cycle operations.
• Management experience: at least 2 years.
• Expert knowledge of EDI 270/271 transactions and payer portals.
• Familiarity with Medicare, Medicaid and commercial payer rules.
• Proficiency with major EHR platforms (Epic, Cerner, Meditech).
• Experience with clearinghouses like Availity or Change Healthcare.

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.

Skills

Insurance verification

Eligibility management

Revenue cycle operations

Payer systems

Attention to detail

English communication

Tools

Epic

Cerner

Meditech

Availity

Change Healthcare

Job description

Mercor is partnering with a leading AI research lab to advance front-end revenue cycle automation. We are seeking an experienced Insurance Verification and Eligibility & Benefits Manager to oversee workflows across commercial, Medicare, Medicaid, and managed care payers.

You will verify coverage via payer portals and real-time eligibility tools, annotate AI outputs, develop SOPs, and monitor KPIs while ensuring HIPAA compliance.