Verify patient insurance coverage using payer portals, clearinghouses, and EDI 270/271 real-time ... Ensure compliance with payer-specific requirements, CMS guidelines , and HIPAA regulations
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Verify patient insurance coverage using payer portals, clearinghouses, and EDI 270/271 real-time ... Ensure compliance with payer-specific requirements, CMS guidelines , and HIPAA regulations
Senior HRIS and Benefits Specialist
Oakland, CA · On-site +1
$93K - $119K/yr
Manage EDI feeds between UKG and benefit carriers, ensuring accurate,timely, HIPAA-compliant data ... No fully remote positions at FF. Join our team as: Senior HRIS and Benefits Specialist Fred Finch ...
Senior HRIS and Benefits Specialist
Oakland, CA · On-site +1
$93K - $119K/yr
Manage EDI feeds between UKG and benefit carriers, ensuring accurate,timely, HIPAA-compliant data ... No fully remote positions at FF. Join our team as: Senior HRIS and Benefits Specialist Fred Finch ...
Senior HRIS and Benefits Specialist
San Diego, CA · On-site +1
$93K - $119K/yr
Manage EDI feeds between UKG and benefit carriers, ensuring accurate,timely, HIPAA-compliant data ... No fully remote positions at FF. Join our team as: Senior HRIS and Benefits Specialist Fred Finch ...
Senior HRIS and Benefits Specialist
San Diego, CA · On-site +1
$93K - $119K/yr
Manage EDI feeds between UKG and benefit carriers, ensuring accurate,timely, HIPAA-compliant data ... No fully remote positions at FF. Join our team as: Senior HRIS and Benefits Specialist Fred Finch ...
Remote Edi Hipaa information
What is a Remote EDI HIPAA specialist?
A Remote EDI HIPAA Specialist is a professional who manages and monitors the electronic exchange of healthcare information in compliance with HIPAA regulations, while working remotely. They ensure that electronic data interchange (EDI) transactions, such as insurance claims and patient records, are securely transferred between healthcare providers, payers, and other entities. Their role involves troubleshooting data transmission issues, maintaining data privacy and security, and ensuring all processes adhere to HIPAA standards. Strong knowledge of healthcare data formats, EDI standards, and federal privacy laws is essential in this position.
What are the key skills and qualifications needed to thrive as a Remote EDI HIPAA specialist?
To thrive as a Remote EDI HIPAA Specialist, you need in-depth knowledge of electronic data interchange (EDI), healthcare transaction sets (such as 837 and 835), and strong familiarity with HIPAA compliance requirements, often supported by a relevant degree or certification. Proficiency in EDI mapping tools, transaction monitoring systems, and healthcare management software like X12, Sterling Gentran, or similar platforms is essential. Excellent analytical skills, attention to detail, and strong communication make you stand out when troubleshooting issues and collaborating with payers or providers remotely. These skills are crucial to ensure accurate, secure, and compliant healthcare data transactions in a virtual environment.
What are some common challenges faced by Remote EDI HIPAA professionals, and how can they be managed effectively?
Remote EDI HIPAA professionals often encounter challenges such as ensuring secure data transmission, maintaining compliance with constantly evolving HIPAA regulations, and troubleshooting EDI transaction errors without onsite support. To manage these effectively, it's important to stay updated on regulatory changes, utilize secure communication tools, and develop strong documentation and troubleshooting skills. Regular communication with IT, compliance, and healthcare partners is also key to resolving issues promptly and maintaining smooth operations.
What is the difference between Remote Edi Hipaa vs Remote Medical Biller?
| Aspect | Remote Edi Hipaa | Remote Medical Biller |
|---|---|---|
| Certifications | HIPAA compliance, EDI standards | Medical billing certifications (e.g., CPC, CPC-H) |
| Work Environment | Electronic data interchange processing, compliance-focused | Billing, coding, and insurance claim submission |
| Industry Usage | Healthcare, insurance, EDI providers | Healthcare providers, billing companies |
| Search/Comparison Intent | Focus on HIPAA and EDI compliance roles | Focus on billing and coding tasks |
Remote Edi Hipaa specialists primarily handle electronic data interchange and HIPAA compliance, ensuring secure transmission of healthcare data. Remote Medical Billers focus on submitting insurance claims and coding. While both roles work remotely in healthcare, EDI Hipaa roles emphasize data security and standards, whereas Medical Billers concentrate on billing processes and reimbursements.
What are popular job titles related to Remote Edi Hipaa jobs in California?
For Remote Edi Hipaa jobs in California, the most frequently searched job titles are:
What job categories do people searching Remote Edi Hipaa jobs in California look for?
The top searched job categories for Remote Edi Hipaa jobs in California are:
What cities in California are hiring for Remote Edi Hipaa jobs?
Cities in California with the most Remote Edi Hipaa job openings:
$105/hr
Full-time
Posted 6 days ago
Job description
About the job
Mercor connects elite creative and technical talent with leading AI research labs. Headquartered in San Francisco, our investors include Benchmark, General Catalyst, Peter Thiel, Adam D'Angelo, Larry Summers, and Jack Dorsey.
Position: Insurance Verification & Benefit Manager
Type: Contract
Compensation: $105/hour
Location: Remote
Role Responsibilities
- Oversee insurance verification, eligibility determination, and benefits investigation workflows across 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 prior to service delivery.
- Evaluate and annotate AI-generated eligibility verification outputs for accuracy, completeness, and payer compliance.
- Develop and document SOPs for eligibility and benefits verification workflows.
- Monitor KPIs including verification accuracy rates, front-end denial rates related to eligibility, and turnaround times.
- Ensure compliance with 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.
Qualifications
Must-Have
- 5+ years of experience in insurance verification, eligibility and benefits management, or front-end revenue cycle operations, with 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 EHR platforms.
- Experience with clearinghouse platforms such as Availity, Change Healthcare, or similar.
- Exceptional written and verbal English communication skills.
- High attention to detail with the ability to identify subtle discrepancies in coverage data.
Preferred
- CHAM, CHAA, or equivalent front-end revenue cycle certification.
- Experience with automated eligibility verification tools and RPA 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.
Application Process (Takes 20–30 mins to complete)
- Upload resume
- AI interview based on your resume
- Submit form
Resources & Support
- For details about the interview process and platform information, please check: https://talent.docs.mercor.com/welcome
- For any help or support, reach out to: support@mercor.com
PS: Our team reviews applications daily. Please complete your AI interview and application steps to be considered for this opportunity.