Senior Eligibility & Benefits Manager — Remote

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

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.