RCM Insurance (Benefits) Verification Advisor (23655)

RCM Insurance (Benefits) Verification Advisor

Position Type Full Time Category Finance

The Benefits Verification Advisor supports the Revenue Cycle Management (RCM) department by ensuring accurate, timely, and compliant insurance verification before admission and throughout the patient stay. This high?volume role partners closely with Admissions, Business Office, Clinical Operations, Case Management, and Managed Care teams to reduce authorization delays, minimize denials, improve reimbursement accuracy, and accelerate revenue cycle performance. The Advisor must demonstrate exceptional knowledge of Medicare, Medicaid, Managed Medicare, Commercial Insurance, Managed Care Organizations, Workers' Compensation, Veterans benefits, and complex payer guidelines.

Qualifications

Associate degree or equivalent experience

Minimum 3 years of healthcare insurance verification or patient access experience

Experience supporting Skilled Nursing Facilities (SNF), Long?Term Care, Home Health, Hospice, or Therapy services

Strong understanding of:

Medicare Parts A, B, C & D

Medicaid

Managed Medicare

Commercial insurance

Managed Care Organizations

Knowledge of prior authorization processes and coordination of benefits

Experience working in high?volume environments

Excellent analytical, problem?solving, and communication skills

Ability to manage multiple priorities while maintaining accuracy

Essential Functions

Serve as the centralized subject matter expert (SME) for insurance eligibility, benefits verification, prior authorizations, and complex payer requirements across SNFs and ancillary service lines

Verify insurance eligibility, benefits, Medicare/Medicaid coverage, managed care plans, coordination of benefits, deductibles, copays, coinsurance, spend?downs, and patient financial responsibility prior to admission and throughout the patient stay

Obtain, monitor, and manage prior authorizations while ensuring compliance with payer guidelines, timelines, and documentation requirements

Collaborate with Admissions, Business Office, Clinical Operations, Case Management, Managed Care, and RCM teams to resolve insurance issues, support timely admissions, and improve reimbursement outcomes

Interpret complex payer contracts, coverage limitations, and medical necessity requirements to ensure accurate financial clearance

Identify and proactively resolve insurance discrepancies, coverage gaps, authorization issues, and payer denials by working directly with insurance carriers and internal stakeholders

Maintain accurate documentation of verification activities, payer communications, authorizations, and eligibility determinations within EMR and revenue cycle systems

Monitor payer trends, regulatory updates, and reimbursement changes; educate internal teams on evolving Medicare, Medicaid, managed care, and commercial insurance requirements

Support revenue cycle performance by reducing preventable denials, improving first?pass claim acceptance, accelerating authorization turnaround times, and ensuring accurate insurance verification prior to billing

Participate in continuous process improvement initiatives by developing standardized workflows, identifying operational efficiencies, and recommending best practices

Ensure compliance with CMS regulations, payer policies, HIPAA requirements, and organizational standards while maintaining exceptional customer service and confidentiality

Perform other duties as assigned

We are an Equal Opportunity Employer. We offer an excellent benefit plan to include 401(k) with match, CEU reimbursement, vacation, sick time, holidays, medical, dental, and supplemental insurance plans, as well as a highly competitive compensation package.