RCM Support Staff Eligibility

We are seeking an experienced RCM Eligibility Specialist to support revenue cycle operations through accurate insurance verification, financial clearance, and claim review activities. This role plays a vital part in ensuring patient accounts are properly validated, claim issues are resolved quickly, and clean claims are submitted for timely reimbursement.

The ideal candidate will have a strong background in medical billing, eligibility verification, and insurance processes. Success in this role requires exceptional attention to detail, problem-solving abilities, and the ability to thrive in a fast-paced environment.

Key Responsibilities

Eligibility Verification

• Verify patient insurance coverage, benefits, and eligibility for healthcare services.
• Review insurance information to ensure accurate financial clearance prior to billing.
• Communicate with patients, providers, insurance carriers, and internal team members to verify coverage details and resolve discrepancies.
• Accurately document eligibility and benefit information within the revenue cycle management system.
• Identify and address coverage issues that could impact billing and reimbursement.

Claim Error Resolution

• Review and resolve claim edits, billing discrepancies, and missing claim information.
• Investigate and correct claim errors to ensure clean claim submission and timely payment.
• Collaborate with billing, coding, and revenue cycle teams to resolve issues and maintain compliance with established procedures.
• Evaluate and resolve issues related to medical necessity and supporting documentation.
• Assist with additional revenue cycle projects and duties as assigned.

Qualifications:

• Bachelor's degree preferred or equivalent combination of education and relevant experience.
• Minimum of 5 years of experience in medical billing, insurance verification, financial clearance, revenue cycle management, or a related healthcare role.
• Strong understanding of insurance policies, billing procedures, claim processing, and reimbursement practices.
• Working knowledge of HIPAA regulations and the handling of protected health information (PHI).
• Excellent verbal and written communication skills.
• Strong analytical, organizational, and problem-solving abilities.
• Ability to manage multiple priorities while maintaining a high level of accuracy.

Preferred Experience

• Experience within laboratory billing, diagnostic testing, or healthcare revenue cycle environments.
• Familiarity with laboratory billing platforms such as Telcor, Xifin, or Quadax.
• Experience reviewing claim edits, medical necessity requirements, and billing compliance standards.

Compensation

About Us

Robert Half is the world’s first and largest specialized talent solutions firm that connects highly qualified job seekers to opportunities at great companies. We offer contract, temporary and permanent placement solutions for finance and accounting, technology, marketing and creative, legal, and administrative and customer support roles.

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All applicants applying for U.S. job openings must be legally authorized to work in the United States. Benefits are available to contract/temporary professionals, including medical, vision, dental, and life and disability insurance. Hired contract/temporary professionals are also eligible to enroll in our company 401(k) plan. Visit roberthalf.gobenefits.net for more information.

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