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Oshi Health is seeking an Eligibility & Benefits Specialist to join its Revenue Cycle team. This role is responsible for verifying patient insurance eligibility and benefits, obtaining required referrals, and communicating coverage and financial responsibility to patients. You will work closely with Revenue Cycle Leads, clinical operations, and payer partners to improve the patient financial experience, reduce claim denials, and support efficient revenue cycle operations.
Key responsibilities include: verifying patient insurance eligibility, benefits, authorization requirements, and referral needs prior to services; obtaining referrals from primary care providers and ensuring all requirements are met; tracking referral status and proactively following up with provider offices, payers, and patients; accurately documenting insurance coverage and eligibility details in internal systems; communicating insurance coverage and estimated out-of-pocket costs to patients in a clear and empathetic manner; researching and resolving eligibility, coverage, and insurance discrepancies; monitoring eligibility verification queues and insurance changes; identifying and resolving claim rejections related to eligibility issues; maintaining open communication with patients, providers, payers, and internal stakeholders; collaborating with Billing, Accounts Receivable, and Clinical Operations teams; analyzing eligibility and referral data to identify trends and improvement opportunities; monitoring and reporting on eligibility metrics; contributing to workflow enhancements; and ensuring compliance with organizational policies, payer requirements, HIPAA, and healthcare regulations.
Required qualifications: Bachelor's degree in Business Administration or relevant coursework; 2+ years of healthcare revenue cycle experience with focus on eligibility, benefits, insurance verification, or patient access; experience verifying insurance eligibility and benefits across multiple commercial and government payers; hands-on experience with payer portals, Availity, and insurance verification tools; proven ability to work independently in a remote environment; proficiency with EMR and insurance verification systems; strong customer service and communication skills; strong organizational, analytical, and problem-solving skills with exceptional attention to detail; proficiency with Google Workspace. Preferred: experience in startup or high-growth healthcare organizations, telehealth/virtual care experience, and familiarity with revenue cycle workflows including billing and claims.
Schedule: Monday-Friday, 10:00 AM - 6:30 PM EST. Full-time position. Must currently reside and plan to reside in one of the following states: Arizona, Delaware, Florida, Georgia, Idaho, Indiana, Louisiana, Missouri, New Hampshire, North Carolina, South Carolina, Tennessee, Texas, Vermont, or Virginia.
