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About the role
Key responsibilities & impact- Verify insurance eligibility and benefits, ensuring accurate coverage details (e.g., copays, deductibles, visit limits) are documented prior to services.
- Obtain and manage prior authorizations and referrals, ensuring payer requirements are met to support timely reimbursement.
- Ensure accurate and up-to-date payer and member insurance information is maintained in systems to prevent claim rejections and delays.
- Identify and resolve eligibility discrepancies, coverage issues, and missing information proactively.
- Support members in navigating employer-sponsored benefits, EAP programs, and insurance coverage, helping them understand financial responsibility and access to care.
- Respond to billing, eligibility, and coverage-related inquiries from members with clarity, accuracy, and empathy.
- Partner with internal teams (clinical, operations, customer support) and external stakeholders (payers, employer partners) to resolve eligibility and authorization issues.
- Serve as a subject matter resource for front-end RCM workflows and payer requirements.
- Own assigned worklists ensuring completion within established productivity, quality, and SLA expectations.
- Resolve claim denials due to eligibility or authorization related issues.
- Prioritize daily work effectively across competing deadlines, understanding how tasks impact downstream billing and member experience.
- Apply established workflows and sound judgment when resolving eligibility and authorization issues.
- Maintain accurate and complete documentation of eligibility checks, authorizations, and member interactions to support auditability and compliance.
- Identify trends in eligibility errors, authorization delays, claim denials, or payer issues, and escalate or suggest process improvements.
- Support audits and quality reviews related to financial clearance processes.
- Contribute to process improvements, including automation and system enhancements, to improve efficiency and reduce manual work.
- Collaborate with internal and external stakeholders to resolve complex eligibility, authorization, and coverage issues.
- Escalate high-risk or time-sensitive cases appropriately to prevent care delays or claim denials.
- Identify workflow gaps and contribute to solutions that improve financial clearance accuracy and efficiency.
Requirements
What you’ll need- 2–3+ years of experience in healthcare revenue cycle, eligibility verification, authorizations, or related operational roles
- Working knowledge of insurance eligibility, benefits, authorizations, and payer requirements
- Strong attention to detail and ability to maintain accuracy in high-volume workflows
- Ability to manage multiple priorities and meet productivity and SLA expectations
- Strong problem-solving skills and ability to navigate ambiguous or incomplete information
- Excellent communication skills, with the ability to explain complex insurance concepts clearly to members and stakeholders.
- Experience with EAPs, employer-sponsored benefits, and behavioral health coverage (preferred)
- Familiarity with payer portals, eligibility tools, and authorization systems (preferred)
- Experience in member-facing support or customer service within healthcare (preferred)
- Experience with process improvement, automation, or AI-enabled workflow initiatives (preferred)
Benefits
Comp & perks- Comprehensive healthcare coverage
- Monthly wellness stipend
- Retirement savings match
- Lifetime Headspace membership
- Generous parental leave
- Stock awards
ATS Keywords
✓ Tailor your resumeApplicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills & Tools
insurance eligibility verificationprior authorizationsclaims managementbilling inquiriesfinancial clearance processesprocess improvementautomationEAP programsbehavioral health coveragepayer requirements
Soft Skills
attention to detailproblem-solvingcommunicationtime managementempathycollaborationorganizational skillsadaptabilitycritical thinkingcustomer service