Senior Eligibility Specialist – RCM

This is a fully remote position, open to applicants in United States.

📋 Description

• Supervise the verification process of patient eligibility and benefits across all insurance providers, ensuring the accuracy and completeness of information.

• Detect and resolve discrepancies in eligibility to avert delays in billing and reimbursement.

• Manage complex and escalated eligibility challenges in collaboration with payers and other departments.

• Provide mentorship and guidance to junior eligibility specialists on advanced issues, intricate cases, best practices, and established procedures.

• Partner with billing, coding, and payer relations teams to proactively tackle eligibility and benefit verification challenges.

• Keep payer systems updated with the latest eligibility information.

• Track changes in payer policies and insurance coverage requirements to minimize claim denials.

• Produce and assess reports on eligibility verification, payer-specific trends, discrepancies, and best practices.

• Evaluate performance reports, identify trends and areas for improvement, and communicate insights to management.

⛳️ Requirements

• Proven experience in patient eligibility verification and insurance benefits processing.

• Strong analytical skills with the ability to identify discrepancies and propose effective solutions.

• Excellent communication skills for liaising with various departments and payers.

• Ability to mentor and train junior staff effectively.

• Familiarity with billing, coding, and payer relations processes.

🏝️ Benefits

• Competitive salary and comprehensive health benefits.

• Opportunities for professional development and career advancement.

• Collaborative and supportive work environment.