AI-Driven Insurance Verification Lead

Mercor; San Francisco (CA); On-site; USD 120,000 - 180,000; Full time

Job summary

Mercor is partnering with a leading AI research lab to advance AI-enabled revenue cycle tools. We seek experienced Insurance Verification and Eligibility & Benefits Managers to oversee verification workflows, eligibility determinations, and benefits investigations across commercial, Medicare, Medicaid, and managed care payers.

You will annotate AI outputs for accuracy, develop SOPs, and monitor KPIs while ensuring HIPAA compliance and payer-specific requirements.

Qualifications

• 5+ years in insurance verification, eligibility and benefits management, 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.

Responsibilities

• Oversee verification, eligibility determination, and benefits workflows across commercial, Medicare, Medicaid, and managed care payers.
• Verify patient insurance coverage using payer portals, clearinghouses, and EDI 270/271 transactions.
• Identify and resolve COB issues, coverage gaps, and eligibility discrepancies before service delivery.
• Evaluate and annotate AI-generated eligibility outputs for accuracy and payer compliance.
• Develop SOPs for eligibility and benefits verification workflows.
• Monitor KPIs like verification accuracy, denial rates, and turnaround times.
• Ensure compliance with CMS guidelines and HIPAA regulations.
• Identify process gaps and recommend workflow improvements to reduce denials.
• Provide structured feedback to support AI training datasets.

Skills

Insurance verification

Eligibility determination

Benefits management

Payer portals

EDI 270/271

EHR proficiency

Tools

Epic

Cerner

Meditech

Availity

Change Healthcare

Job description

Mercor is partnering with a leading AI research lab to advance AI-enabled revenue cycle tools. We seek experienced Insurance Verification and Eligibility & Benefits Managers to oversee verification workflows, eligibility determinations, and benefits investigations across commercial, Medicare, Medicaid, and managed care payers.

You will annotate AI outputs for accuracy, develop SOPs, and monitor KPIs while ensuring HIPAA compliance and payer-specific requirements.