Eligibility and Benefits Verification Specialist - (WI)

This is a remote position.

Job Summary

RCM Staff BPO is hiring a full-time Eligibility and Benefits Verification Specialist to support a behavioral health provider group based in Wisconsin.

The specialist verifies patient insurance coverage and benefits ahead of scheduled visits, documents findings in the practice's EHR, and flags coverage issues to the practice before the appointment. This role requires strong attention to detail, consistent follow-up, and experience working with U.S. health insurance plans.

Key Responsibilities

• Verify patient eligibility and active coverage for upcoming appointments using payer portals, Availity, and payer phone lines
• Confirm behavioral health benefits including copay, coinsurance, deductible, out-of-pocket status, visit limits, and telehealth coverage
• Identify behavioral health carve-outs and confirm the correct payer and claims-submission payer ID
• Check whether prior authorization is required for scheduled services and note the requirement and status
• Verify primary and secondary coverage and coordination of benefits
• Document verification results in the practice's EHR using the standard note format, including the date benefits were quoted
• Escalate coverage problems to the practice contact with a clear decision request before the visit
• Complete assigned daily verification queues within the practice's turnaround times
• Protect patient information and follow HIPAA requirements

Qualifications

• At least 1 year of experience with U.S. healthcare insurance
• Hands-on experience with eligibility and benefits verification
• Familiarity with commercial insurance and government health plans, including Medicare and Medicaid
• Experience using payer portals and insurance websites

•Strong written and spoken English

• Excellent attention to detail and follow-up skills
• Ability to work independently and manage multiple patient accounts
• Reliable internet connection and a suitable remote workspace

Preferred Qualifications

• Experience supporting behavioral health, psychiatry, or mental health counseling practices

•Experience using PracticeQ (IntakeQ)

• Familiarity with Wisconsin insurance plans, including Wisconsin Medicaid and BadgerCare Plus
• Experience verifying behavioral health carve-outs, visit limits, and telehealth benefits

Schedule

•Full-time position

• Must be available during Central Time business hours
• Final schedule will be determined based on practice needs

Work Arrangement

•Remote

•Philippines-based applicants preferred

Originally posted on Himalayas