Benefits Investigation & Eligibility Specialist

Baylor Genetics; Northern (KY); Hybrid; USD 42,000 - 66,000; Full time

Job summary

Baylor Genetics is seeking a Benefits Investigation & Eligibility Specialist to verify insurance eligibility and investigate benefits for genetic testing. You will confirm coverage details, collect payer requirements, and document findings to prevent reimbursement delays.

The role requires strong attention to detail, initiative, and ability to work with patients, provider offices, payers, and internal teams. Remote position with a focus on accuracy and timely information.

Qualifications

• High school diploma or equivalent.
• 2+ years in healthcare insurance verification, benefits investigation, patient access, revenue cycle, or related function.
• Working knowledge of commercial insurance, Medicare, Medicaid, and managed care plans.
• Experience using payer portals, electronic eligibility tools, and healthcare or revenue cycle systems.

Responsibilities

• Verify active insurance coverage and payer requirements across multiple lines of coverage.
• Use payer portals and electronic tools to validate and correct information.
• Contact patients/provider offices to obtain missing data and resolve issues that delay testing or reimbursement.
• Investigate patient benefits including deductibles, copays, coinsurance, and network requirements.
• Identify prior authorizations and payer requirements; route cases with complete info.
• Document findings, references, and follow-up actions in the system.
• Communicate eligibility findings clearly to patients and internal teams without guarantees.
• Manage work queues, prioritize time-sensitive cases, and meet productivity/quality targets.
• Participate in training, quality reviews, and HIPAA/compliance activities.

Skills

Attention to detail

Communication

Problem solving

Organization

Data entry accuracy

Education

High school diploma or equivalent

Associate degree in healthcare administration

Tools

Quadax

Salesforce

Clearinghouses

Payer portals

Job description

Benefits Investigation & Eligibility Specialist

Job Category: Revenue Cycle Management

Requisition Number: BENEF002525

• Posted : September 15, 2026
• Full-Time
• Remote

Locations

Showing 1 location

Remote
United States

Description

JOB SUMMARY

The Benefits Investigation & Eligibility Specialist verifies patient insurance eligibility and investigates benefits for genetic and molecular diagnostic testing. This role confirms active coverage, identifies patient benefit information and payer requirements, resolves missing or conflicting insurance information, and documents findings accurately so cases can move forward without avoidable reimbursement delays.

The ideal candidate is self-directed, resourceful, and able to solve problems independently while knowing when to escape. Strong attention to detail and a patient-centered approach are required. The Specialist works with patients, provider offices, payers, and internal teams to provide clear, accurate, and timely insurance information.

KEY RESPONSIBILITIES

• Verify active primary, secondary, and tertiary insurance coverage; confirm member details, demographics, effective dates, plan type, payer information, and coordination-of-benefits requirements.
• Use payer portals, electronic eligibility tools, and direct payer contact to validate coverage and resolve inactive, terminated, incorrect, incomplete, or conflicting insurance information.
• Contact patients and provider offices professionally to obtain missing or corrected insurance information and escalated unresolved issues that may delay testing, billing, or reimbursement.
• Investigate patient-specific benefits for genetic and molecular diagnostic services, including deductibles, copayments, coinsurance, out-of-pocket amounts, benefit limitations, and network requirements.
• Identify prior authorization, notification, referral, medical records, and other payer requirements; route cases to the appropriate team with complete supporting information.
• Document benefit findings, payer representatives, reference numbers, call dates, portal results, and follow-up actions accurately in the designated system.
• Communicate eligibility and benefit findings clearly to patients, provider offices, and internal teams using approved language without making coverage guarantees.
• Manage assigned work queues independently, prioritize time-sensitive cases, follow up within established turnaround times, and meet productivity and quality expectations.
• Research and resolve routine issues, review work for accuracy and completeness, maintain auditable documentation, and escalated payer, system, or policy issues appropriately.
• Participate in training, quality reviews, and workflow improvements while following HIPAA, Baylor Genetics policies, and applicable payer and regulatory requirements.

QUALIFICATIONS

Required

• High school diploma or equivalent.
• 2+ years of experience in healthcare insurance verification, benefits investigation, patient access, revenue cycle, or a related function.
• Working knowledge of commercial insurance, Medicare, Medicaid, and managed care plans.
• Experience using payer portals, electronic eligibility tools, and healthcare or revenue cycle systems.
• Ability to work independently, research issues, make sound decisions within established procedures, and escalated appropriately.
• Strong problem-solving skills and the ability to resolve incomplete, conflicting, or unclear insurance information.
• Exceptional attention to detail and accuracy in data entry, documentation, and follow-up.
• Strong written and verbal communication skills with a professional, patient-centered approach.
• Ability to manage multiple cases and priorities in a production-based environment.
• Ability to handle protected health information and confidential financial information appropriately.

Preferred

• Associate degree in healthcare administration, business, or a related field.
• Experience in diagnostic laboratory, genetics, molecular diagnostics, pathology, or specialty healthcare.
• Experience with Quadax, Salesforce, clearinghouses, payer portals, or similar systems.
• Familiarity with prior authorization workflows, payer medical policies, and patient financial responsibility.

COMPETENCIES

• Problem Solving & Resourcefulness
• Attention to Detail & Documentation Accuracy
• Patient-Centered Communication
• Ownership & Follow-Through

PHYSICAL DEMANDS AND WORK ENVIRONMENT

• Work is primarily computer- and telephone-based and frequently requires sitting, keyboard and mouse use, speaking, listening, and reviewing electronic information.
• Regular interaction with patients, provider offices, payers, and internal operational teams.
• Protect patient, client, financial, and company information in accordance with HIPAA and Baylor Genetics policies.
• Perform other job-related duties as assigned. Reasonable accommodations will be provided in accordance with applicable law.

EEO STATEMENT

Baylor Genetics is proud to be an equal opportunity employer committed to fostering an inclusive and diverse workplace. We welcome and encourage applicants from all backgrounds to apply. We do not discriminate on the basis of race, color, religion, national origin, sex, sexual orientation, gender identity, age, veteran status, disability, genetic information, pregnancy, childbirth, or any other status protected by applicable federal, state, or local law. If you need an accommodation during the application process, please contact our Human Resources team.

Equal Opportunity Employer
This employer is required to notify all applicants of their rights pursuant to federal employment laws.For further information, please review the Know Your Rights notice from the Department of Labor.