Eligibility and Benefits Specialist

Position Summary

The Eligibility and Benefits Specialist will play a key role in confirming patient insurance coverage and facilitating access to care by verifying eligibility, benefits, and referrals. Reporting to the Lead Revenue Cycle, this full-time, remote position is open to candidates currently residing and working within specific US states: Arizona, Delaware, Florida, Georgia, Idaho, Indiana, Louisiana, Missouri, New Hampshire, North Carolina, South Carolina, Tennessee, Texas, Vermont, and Virginia. The regular work schedule is Monday through Friday, from 7 AM to 4 PM Eastern Time.

Primary Responsibilities

• Confirm patients' insurance eligibility and benefit details, including authorization and referral requirements before services are provided.
• Coordinate and secure necessary referrals from primary care and referring physicians to meet all prerequisites for scheduling/treatment.
• Monitor referral statuses and proactively follow up with providers, payers, and patients to ensure referrals are valid and received timely.
• Precisely record insurance coverage, benefits, referrals, and eligibility information in internal systems.
• Communicate coverage details, financial responsibilities, and estimated out-of-pocket costs to patients in a clear, professional, and compassionate manner.
• Investigate and resolve any discrepancies regarding eligibility, coverage, referrals, or insurance that could affect patient care or reimbursement.
• Keep eligibility verification queues, insurance updates, and pending requests under close review to ensure resolution without delay.
• Identify and address claim rejections related to insurance and referral issues.
• Maintain open communication lines among patients, providers, payers, and internal stakeholders to clarify insurance-related questions.
• Collaborate cross-functionally with Billing, Accounts Receivable, and Clinical Operations to enhance patient access and billing accuracy.
• Analyze data related to eligibility, referrals, and benefit verification to recognize patterns and improvement opportunities.
• Report on key verification metrics to support operational performance and continuous process enhancement.
• Suggest and participate in workflow improvements aimed at operational efficiency and reduction of claim denials.
• Ensure all practices comply with company policies, payer requirements, HIPAA, and healthcare billing regulations.

Required Qualifications

• Bachelor's degree in Business Administration or a related field.
• Minimum of 2 years experience in healthcare revenue cycle focusing on eligibility verification, benefits, authorizations, or patient access.
• Proficient in handling insurance verification across commercial and government payers using payer portals such as Availity, and phone verification.
• Proven ability to excel in remote work settings and independently manage priorities.
• Familiarity with EMR and insurance verification systems.
• Excellent customer service, communication, and interpersonal abilities.
• Strong organizational, analytical, and problem-solving expertise with meticulous attention to detail.
• Comfortable using Google Workspace tools and capable of quickly adapting to new technologies.

Preferred Experience

• Background in startups or rapidly growing healthcare organizations.
• Exposure to telehealth or virtual care environments.
• Familiarity with revenue cycle workflow, including billing, claims, and accounts receivable processes.
• Experience with healthcare platforms such as Athenahealth, Apero, Salesforce or similar.
• Skills in monitoring operational metrics and driving process improvements.
• Certifications such as Certified Revenue Cycle Representative (CRCR) are a plus.

Compensation and Benefits

• Annual salary range between $47,000 and $52,000 with eligibility for bonuses.
• Employer-sponsored medical, dental, and vision insurance plans.
• Unlimited paid time off plus 11 paid company holidays annually.
• 401(k) plan participation eligibility.
• A remote-first culture allowing work from home within approved states.
• Customizable career growth opportunities aligned with company scaling.
• Access to life management services through a concierge program.

About the Company

Oshi Health is a virtual digestive health practice dedicated to revolutionizing gastrointestinal care by integrating compassionate, multi-disciplinary treatment with innovative technology. The organization’s digital care model facilitates convenient, comprehensive patient management that emphasizes a whole-person approach including symptom investigation, medication, dietary, and mental health interventions.

Workplace Culture and Commitment

• Passion for improving patient lives and transforming GI healthcare.
• Effective communication and emotional intelligence.
• Adaptability to a dynamic, remote-first, mission-driven workplace.

Equal Opportunity and Workplace Policy

Oshi Health is an equal opportunity employer fostering a respectful, inclusive environment and prohibits discrimination or harassment based on legally protected characteristics. All employment actions adhere strictly to these principles to maintain a fair and dignified workplace.

Additional Notes

The job description is a general outline and may change to address evolving organizational needs. Oshi Health cautions candidates to be vigilant against fraudulent communications and confirms all official correspondence is via email only. Candidates are never asked for sensitive financial information or to make purchases for employment processes.