Eligibility and Benefits Manager – US Healthcare RCM

Position Overview

The Eligibility and Benefits Manager will oversee and optimize the eligibility verification, benefits coordination, claims submission, and remittance processes within the Revenue Cycle Management (RCM) framework. This role ensures compliance with HIPAA standards, accuracy in patient coverage validation, and seamless communication between providers and payers using EDI transactions.

Key Responsibilities

Eligibility Verification (EDI 270/271):

• Manage and monitor eligibility inquiries (270) to confirm patient insurance coverage before service.
• Interpret eligibility responses (271) to ensure accurate benefit details, including co-pays, deductibles, and coverage limits.
• Implement automated workflows to reduce eligibility-related deni...