Insurance Verification Manager - Expert

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 working with a leading AI research lab to improve the capabilities of next-generation AI systems. We are seeking experienced Insurance Verification and Eligibility & Benefits Managers to evaluate AI tools designed to automate front-end revenue cycle operations. Your deep expertise in payer systems, EDI transactions, and eligibility workflows will directly inform AI models that drive accuracy and efficiency in insurance verification processes.

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.

Requirements

• 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 Qualifications

• 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.

Why Join?

• Contribute to the development of frontier AI systems in healthcare.
• Collaborate with a world-class AI research organisation.
• Gain exposure to cutting-edge AI workflows in healthcare revenue cycle management.
• Opportunity to work on high-impact projects shaping the future of healthcare AI.