Eligibility & Benefits Manager - Remote | Upto $105/hr

mercor; United States; Remote; USD 123,000 - 167,000; Full time

Job summary

Mercor is seeking an Insurance Verification & Benefit Manager for a remote contract role. You will oversee verification, eligibility, and benefits workflows, coordinate with payers, and ensure compliance with HIPAA and CMS guidelines.

Ideal candidates have 5+ years in verification/benefits with 2+ years in management, and strong experience with EHRs (Epic/Cerner/Meditech) and payer portals.

Qualifications

• 5+ years of experience in insurance verification and benefits management.
• 2+ years in a management role.
• Expert knowledge of EDI 270/271 transactions and payer portals.
• Familiarity with Medicare, Medicaid, and commercial payer eligibility requirements.
• Experience with Epic, Cerner, Meditech, or equivalent EHR platforms.
• Experience with clearinghouse platforms such as Availity or Change Healthcare.
• Excellent written and verbal English communication skills.
• High attention to detail and accuracy in coverage data.

Responsibilities

• Oversee insurance verification workflows across payers and eligibility determinations.
• Verify patient insurance coverage via payer portals, clearinghouses, and EDI 270/271.
• Identify and resolve COB issues and eligibility discrepancies before service delivery.
• Evaluate AI-generated eligibility outputs for accuracy and payer compliance.
• Develop and document SOPs for verification workflows.
• Monitor KPIs like verification accuracy and denial rates; track turnaround times.
• Ensure compliance with CMS, HIPAA, and payer guidelines.
• Provide feedback to support AI training datasets.

Skills

Insurance verification

Eligibility determination

Benefits management

Contract management

HIPAA compliance

Education

CHAM

CHAA

Tools

Epic

Cerner

Meditech

Availity

Change Healthcare

Job description

About the job

Mercor connects elite creative and technical talent with leading AI research labs. Headquartered in San Francisco, our investors include Benchmark , General Catalyst , Peter Thiel , Adam D'Angelo , Larry Summers , and Jack Dorsey .

Position: Insurance Verification & Benefit Manager

Type: Contract

Compensation: $105/hour

Location: Remote

Role 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 .

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.

Preferred

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