Eligibility Verification Specialist
Verify benefits before the visit so claims do not die after it. You work alongside our eligibility automation, handling what it escalates.
The role
What this job actually is
Mastery of the RCM metric set is mandatory: net collection rate, gross collection rate, days in AR, AR over 90 days, denial rate, first-pass resolution rate, clean claim rate, cost to collect, charge lag and DNFB. You must be able to read them, explain what moves them, and act on them.
You verify coverage and benefits before care is delivered: active coverage, plan type, benefit limits, copay and deductible, and authorization requirements. Our eligibility engine handles the routine 270/271 traffic; you handle the exceptions it escalates and the payers that need a human. Eligibility errors are the single most preventable denial category, and preventing them is the job.
Ownership
What you will own
Accurate verification
Confirm coverage, plan, benefits and patient responsibility before the date of service.
Exception handling
Work what the automation escalates: ambiguous responses, unusual plans, payers without clean electronic responses.
Authorization flagging
Identify when a service needs prior authorization and route it to the auth desk.
Benefit detail capture
Record limits, caps and accumulators that affect what can be billed later.
Front-end denial prevention
Feed recurring eligibility issues back so they stop recurring.
Documentation
Record what you verified and when, so the claim can be defended.
Ramp
Your first 90 days
First 30 days
Learn client payers and plan types, work under review until accuracy is consistent.
By day 60
Working independently at volume with low error rate.
By day 90
Fully productive and contributing prevention feedback.
Requirements
What we look for
- MANDATORY: working command of RCM metrics, net collection rate, days in AR, AR over 90, denial rate, first-pass resolution rate, clean claim rate and cost to collect
- Two or more years in US healthcare eligibility and benefit verification
- Comfortable reading a 271 response and interpreting benefit detail
- Experience with US payer portals and phone verification
- Accuracy discipline under volume
Bonus
Strong plus, not required
- Behavioral health or ABA benefit verification
- Medicaid managed care experience
- Exposure to automated eligibility tooling
Accountability
How this role is measured
| Measure | What it means |
|---|---|
| Verification accuracy | Errors found downstream. |
| Eligibility-related denials | Trending down. |
| Throughput | Verifications per day at standard. |
| Turnaround | Completed before date of service. |
| Exception resolution | Escalations cleared. |
| Documentation quality | Complete and auditable. |
Why ASP-RCM
Why this seat is different
We are senior-led by design. A senior partner is named on accounts and shows up in the work, which is why clients renew and why this role carries real authority rather than a title. Our AI suite is in production, not in a roadmap deck, and our compliance posture is independently audited: SOC 2 Type II with HITRUST, ISO 27001 and HIPAA.
We pay for certifications and run upskilling cohorts, because coding and revenue cycle are crafts that need investment. You will work across Dallas HQ, six US states and Chennai, India, with colleagues who have run these functions at scale.