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Role Overview

The Eligibility amp; Benefits Analyst is responsible for verifying, reviewing, and confirming patient insurance eligibility and benefits information to support accurate intake, authorization, and billing processes. This role focuses on analyzing eligibility and benefits results produced by systems we use for eligibility, validating accuracy, and resolving discrepancies.

The analyst may conduct outreach to patients and/or payers via phone or other communication modalities and research multiple internal and external systems to identify correct insurance coverage when information is incomplete, conflicting, or unavailable. Accuracy, attention to detail, and strong communication skills are critical to ensuring downstream revenue cycle integrity and a positive patient experience.

Responsibilities and Job Duties

Insurance Eligibility amp; Benefits Verification

· Review and interpret insurance eligibility and benefits results presented by our platforms.

· Confirm active coverage, benefit details, plan type, payer requirements, and patient financial responsibility.

· Validate insurance information against source systems to ensure accuracy and completeness prior to authorization, service delivery, or billing.

Issue Resolution amp; Research

· Identify discrepancies, missing information, or inconsistencies in eligibility and benefits results.

· Research internal systems, payer portals, clearinghouses, and other available tools to locate or confirm correct insurance information.

· Escalate complex or unresolved eligibility issues according to established workflows.

Patient amp; Payor Outreach

· Conduct outreach to patients via phone or other communication methods to obtain or clarify insurance information.

· Communicate with insurance carriers as needed to verify eligibility, benefits, or coverage details.

· Document all outreach, findings, and updates clearly and accurately in designated systems.

Job Qualifications amp; Requirements

· 1–4 years of experience in insurance eligibility, benefits verification, healthcare intake, billing, or revenue cycle operations.

· Strong understanding of health insurance concepts, including eligibility, benefits, plan structures, and payer terminology.

· Experience working with eligibility platforms, payer portals, or revenue cycle systems (e.g., Brightree, Tennr or similar tools).

· High attention to detail with the ability to interpret and reconcile insurance information from multiple sources.

· Strong verbal and written communication skills, including comfort with patient and payer outreach.