Insurance Verification & Benefit Manager

Overview

Great Value Hiring is looking for an Insurance Verification & Benefit Manager to help assess AI-driven tools built to streamline front-end revenue cycle processes.

What the role involves

• Lead the end-to-end workflow for insurance verification, eligibility checks, and benefits review across commercial, Medicare, Medicaid, and managed care plans.
• Confirm patient coverage through payer websites, clearinghouses, and EDI 270/271 live eligibility transactions.
• Spot and correct coordination-of-benefits problems, coverage interruptions, and eligibility mismatches before services are delivered.
• Review AI-produced eligibility outputs, checking them for completeness, correctness, and payer-rule alignment.
• Create and maintain SOPs for eligibility and benefits verification processes.
• Track operational metrics such as verification accuracy, front-end denial rates tied to eligibility, and turnaround time.
• Maintain adherence to payer-specific rules, CMS requirements, and HIPAA standards.
• Find workflow bottlenecks and suggest changes that can lower eligibility-related claim denials.
• Deliver structured notes and feedback to support AI model training data.

Requirements

• At least 5 years of experience in insurance verification, eligibility and benefits management, or front-end revenue cycle operations, including a minimum of 2 years in a management position.
• Deep working knowledge of EDI 270/271 transactions, payer portal workflows, and real-time eligibility systems.
• Strong understanding of Medicare, Medicaid, and commercial payer rules and benefit design.
• Hands-on experience with EHR systems such as Epic, Cerner, Meditech, or similar platforms.
• Prior exposure to clearinghouse tools like Availity, Change Healthcare, or comparable systems.
• Excellent written and spoken English communication skills.
• Sharp attention to detail and the ability to catch small inconsistencies in coverage information.

Nice to have

• CHAM, CHAA, or an equivalent front-end revenue cycle certification.
• Experience working with automated eligibility verification tools or RPA-based solutions.
• Background in analyzing the root cause of denials linked to eligibility and coverage issues.
• Comfort evaluating AI-generated healthcare content and using AI tools in workflow assessment.
• Experience presenting eligibility performance metrics to senior stakeholders.

Compensation

Pay is listed at $105 per hour.