Demonstrates expertise in US insurance eligibility and benefits verification, including prior authorization processes and patient responsibility calculations. Proficient in using payer portals and conducting outbound calls for verification while adhering to HIPAA regulations.

Highest-signal resume keywords

US Insurance Eligibility VerificationPrior Authorization ExperiencePayer Portal ProficiencyPatient Responsibility CalculationHIPAA Compliance

Tech Stack

Tools & technologies

SQL

About the role

Key responsibilities & impact

Run eligibility and benefits checks in US payer portals for scheduled patients
Record plan, network status, deductible, out-of-pocket amounts, copay, coinsurance, and prior-authorization requirements in structured forms
Capture portal PDFs or screenshots as evidence for every verification
Mark incomplete or contradictory portal data as unknown instead of guessing
Call payers to verify benefits when portal information is missing or unclear
Confirm whether procedures identified by CPT code require prior authorization
Submit prior-authorization requests and follow up until approval before the date of service
Log representative names, call reference numbers, and outcomes for every payer call
Follow client call scripts and record calls as directed
Calculate estimated patient responsibility using the client's written formula and document the steps
Audit automated output against portal or call results and flag mismatches with specific reasons
Provide engineering with reproducible feedback and report patterns across cases
Document payer portal and phone quirks as short how-to notes
Build and maintain curated checked cases across payers and plan types for regression testing
Re-check older cases when payer rules change
Produce approximately 30 new verifications per day or 100–200 QA checks per day depending on task mix
Report directly to a founder on a small operations and data team

Requirements

What you’ll need

2–5 years of hands-on US insurance eligibility and benefits verification and prior authorization experience in an ASC, hospital, or RCM/BPO setting, at volume of 30+ verifications per day
Daily use of US payer portals such as Availity, UnitedHealthcare, Waystar, or NaviNet
Outbound payer phone calls for benefits verification and prior authorization follow-up, with call reference numbers logged
Ability to explain deductible, coinsurance, copay, and out-of-pocket maximum and calculate patient-responsibility estimates
HIPAA training and PHI handling experience
English at C1+ CEFR written and B2+ CEFR spoken
Availability for synchronous work from 10:00 AM to 5:00/6:00 PM Pacific Time
Verification experience in surgical specialties such as GI, ophthalmology, orthopedics, pain management, or ENT is nice to have
Medicare Advantage and secondary-coverage case experience is nice to have
Experience auditing or QA-ing automated or AI-generated output is nice to have
SQL, data-labeling, or advanced spreadsheet experience is nice to have
Experience working with minimal supervision, writing SOPs, or training others is nice to have

ATS Keywords

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Applicant Tracking System Keywords

Tip: use these terms in your resume and cover letter to boost ATS matches.

Hard Skills

Benefits VerificationPrior Authorization RequestsCPT Code IdentificationData AuditingQA of Automated Output

Soft Skills

Attention to DetailEffective CommunicationProblem-Solving

Tools & Technologies

AvailityUnitedHealthcareWaystarNaviNet

Certifications & Qualifications

HIPAA Training

Industry Keywords

ASCRCMBPOSurgical SpecialtiesMedicare Advantage