- 経験
- どれでも
- 給料
- USD 105 – USD 105 / hour
- 求人情報
- 1
- 投稿済み
- 1週間前
- 作業モード
- 在宅勤務
- 再開する
- 応募必須
仕事内容
Role Overview
This contract position focuses on leveraging advanced front-end revenue cycle expertise to assess and enhance automated eligibility verification systems. The role bridges payer operations and healthcare automation, significantly influencing large-scale eligibility workflow construction and validation.
Key Duties
- Manage comprehensive insurance verification, eligibility assessment, and benefits investigation for commercial, Medicare, Medicaid, and managed care payers, targeting reduction of front-end denials.
- Perform and confirm real-time eligibility checks via EDI 270/271, payer web portals, and clearinghouse platforms, resolving conflicts in coordination of benefits and coverage discrepancies before services are provided.
- Analyze and annotate outputs from large language model-generated eligibility verification to ensure accuracy, completeness, and compliance with payer standards, feeding structured feedback to improve model training datasets.
- Create and update standard operating procedures (SOPs) for eligibility and benefits verification aligned with CMS guidance, payer-specific protocols, and HIPAA requirements.
- Track and communicate key performance indicators (KPIs) such as verification accuracy, eligibility-related denials, and turnaround times to senior leadership.
- Spot systemic inefficiencies and suggest workflow enhancements to minimize eligibility-related claim denials throughout the revenue cycle.
Required Qualifications
- In-depth knowledge of EDI 270/271 transactions, real-time eligibility platforms, and payer portal navigation across commercial, Medicare, and Medicaid benefits.
- Proven leadership experience managing front-end revenue cycle operations including supervision of verification workflows and team outcomes.
- Experienced user of Epic, Cerner, Meditech, or comparable electronic health record systems in high-volume eligibility settings.
- Hands-on familiarity with clearinghouse tools like Availity or Change Healthcare.
- Strong capability to detect nuanced discrepancies in insurance coverage and eligibility information with high accuracy.
- Excellent written communication skill, enabling clear annotation, SOP composition, and detailed performance reporting.
Additional Advantages
- Preferred credentials include CHAM, CHAA, or similar front-end revenue cycle certifications.
- Experience performing root cause analyses of denials related to eligibility and coverage errors.
- Past involvement with Robotic Process Automation (RPA) or automated eligibility verification technologies in healthcare.
Compensation and Work Conditions
Hourly pay of $105 with flexible scheduling, fully remote work arrangement.