Lead the evaluation and validation of AI tools built to automate front-end revenue cycle operations by applying deep, hands-on expertise in payer systems, EDI transactions, and eligibility workflows. You will verify real-world payer interactions, annotate AI outputs for accuracy and compliance, and help shape SOPs and KPI tracking that improve insurance verification processes across commercial, Medicare, Medicaid, and managed care payers.
Key Responsibilities- Oversee insurance verification, eligibility determination, and benefits investigation workflows for commercial, Medicare, Medicaid, and managed care payers.
- Verify patient insurance coverage using payer portals, clearinghouses, and EDI 270/271 real-time eligibility transactions.
- Identify and resolve coordination of benefits issues, coverage gaps, and eligibility discrepancies before services are delivered.
- Evaluate and annotate AI-generated eligibility verification outputs for accuracy, completeness, and payer compliance.
- Develop and document standard operating procedures for eligibility and benefits verification workflows.
- Monitor KPIs, including verification accuracy rates, front-end denial rates related to eligibility, and turnaround times.
- Ensure adherence to payer-specific requirements, CMS guidelines, and HIPAA regulations.
- Identify process gaps and recommend workflow improvements to reduce eligibility-related claim denials.
- Provide structured feedback and annotations to support AI training datasets.
- Minimum 5 years of experience in insurance verification, eligibility and benefits management, or front-end revenue cycle operations, including at least 2 years in a management role.
- Expert knowledge of EDI 270/271 transactions, payer portal navigation, and real-time eligibility tools.
- Strong familiarity with Medicare, Medicaid, and commercial payer eligibility requirements and benefit structures.
- Proficiency with Epic, Cerner, Meditech, or equivalent electronic health record platforms.
- Experience with clearinghouse platforms such as Availity, Change Healthcare, or similar services.
- Exceptional written and verbal English communication skills.
- High attention to detail with the ability to detect subtle discrepancies in coverage data.
- CHAM, CHAA, or equivalent front-end revenue cycle certification.
- Experience with automated eligibility verification tools and robotic process automation solutions.
- Background in denial root cause analysis related to eligibility and coverage errors.
- Familiarity with AI tools and comfort evaluating AI-generated healthcare content.
- Experience presenting eligibility performance data to senior leadership.
- Location: Remote work.
- Employment type: Hourly engagement.
- Hourly rate: 105 - 105 hourly.
Candidates must meet the experience and skill requirements listed above, bringing hands-on payer, EDI, and eligibility workflow expertise to the role. The role focuses on evaluating AI tools for front-end revenue cycle automation and requires direct prior experience with the stated payer types, transactions, EHRs, and clearinghouse platforms.
Why Join- Contribute to the development of advanced AI systems applied to healthcare revenue cycle management.
- Collaborate with a leading AI research organization on high-impact projects.
- Gain exposure to innovative AI workflows and influence tools that improve verification accuracy and reduce claim denials.