Eligibility & Benefits Specialist (RCM)
Reports To: Lead Revenue Cycle
Locations Hiring From: Arizona, Delaware, Florida, Georgia, Idaho, Indiana, Louisiana, Missouri, New Hampshire, North Carolina, South Carolina, Tennessee, Texas, Vermont, Virginia ONLY. Must currently reside and plan on residing in the entire employment.
Schedule: Monday- Friday 7-4pm EST
Employment Type: Full-Time
Role Overview
As an Eligibility & Benefits Specialist, you will be responsible for or verifying patient insurance eligibility and benefits, obtaining required referrals, communicating coverage and financial responsibility, and supporting accurate patient access and reimbursement. This role helps ensure patients understand their insurance benefits, estimated costs, and referral requirements while proactively identifying and resolving coverage issues before services are rendered. You will work closely with our Revenue Cycle Leads, other members of the Revenue Cycle team, and payer partners to improve the patient financial experience, reduce claim denials, and support efficient revenue cycle operations. Your attention to detail, excellent organizational skills, and commitment to customer access will contribute to the financial stability and success of Oshi as we pioneer the way in GI care.
What You'll Do: Key Responsibilities
- Verify patient insurance eligibility, benefits, authorization requirements, and referral needs prior to services.
- Obtain referrals from primary care providers and referring physicians, ensuring all referral requirements are met prior to scheduling or treatment.
- Track referral status and proactively follow up with provider offices, payers, and patients to ensure referrals are received and remain valid.
- Accurately document insurance coverage, benefit information, referrals, and eligibility details within internal systems.
- Communicate insurance coverage, patient financial responsibility, estimated out-of-pocket costs, and Oshi's billing model in a clear, professional, and empathetic manner.
- Research and resolve eligibility, coverage, referral, and insurance discrepancies that may impact patient care or reimbursement.
- Monitor eligibility verification queues, insurance changes, pending requests, and coverage updates to ensure timely resolution.
- Identify and resolve claim rejections related to eligibility, benefits, coverage, or referral issues.
- Maintain open communication with patients, providers, payers, and internal stakeholders to resolve eligibility, referral, and insurance-related questions.
- Collaborate with Billing, Accounts Receivable, Clinical Operations, and other cross-functional teams to improve patient access, billing accuracy, and reimbursement.
- Analyze eligibility, referral, and benefit verification data to identify trends, root causes, and opportunities for process improvement.
- Monitor and report on eligibility, referral, and verification metrics to support operational performance and continuous improvement.
- Contribute to workflow enhancements that improve operational efficiency, reduce claim denials, and enhance the patient financial experience.
- Ensure compliance with organizational policies, payer requirements, HIPAA, and healthcare billing and eligibility regulations.
What We're Looking For: Qualifications & Requirements
Required
- Bachelor's Degree in Business Administration or relevant course work.
- 2+ years of healthcare revenue cycle experience with a focus on eligibility, benefits, insurance verification, or patient access.
- Experience verifying insurance eligibility, benefits, authorizations, and obtaining referrals across multiple commercial and government payers.
- Hands-on experience using payer portals, Availity, and other insurance verification tools, including phone verification.
- Experience working successfully in a remote work environment with the ability to manage priorities independently.
- Proficiency with EMR and insurance verification systems.
- Strong customer service, communication, and interpersonal skills.
- Strong organizational, analytical, and problem-solving skills with exceptional attention to detail.
- Proficiency with Google Workspace (Sheets, Docs, Gmail) and the ability to quickly learn new systems and technology.
Preferred
- Experience in a startup or high-growth healthcare organization.
- Experience in telehealth or virtual care.
- Familiarity with revenue cycle workflows, including billing, claims, and accounts receivable.
- Experience with Athenahealth, Apero, Salesforce, or similar healthcare technology platforms.
- Experience tracking operational metrics and identifying process improvement opportunities.
- Certified Revenue Cycle Representative (CRCR) or other healthcare revenue cycle certification preferred.
Compensation & Benefits
- Salary Range: 47,000-52,000 per year plus bonus eligibility
- Health Benefits: Employer-sponsored medical, dental, and vision coverage
- Time Off: Unlimited PTO + 11 paid company holidays
- Retirement: Eligibility to contribute to 401(k)
- Work Style: Remote-first — work from home within our approved states
- Growth: Tailored professional development opportunities as we scale
- Life Concierge: Access to Overalls, because we know life happens
About Oshi Health
Oshi Health is a virtual digestive health practice on a mission to transform GI care. We combine compassionate, multidisciplinary care with innovative technology to help people with chronic digestive conditions get the answers and relief they deserve. When you join Oshi, you're joining a team and a mission that's changing what great healthcare looks like. Oshi Health is revolutionizing GI care with a digital clinic model that provides easy, convenient access to an integrated and multidisciplinary care team that takes a whole-person approach to diagnosing, managing, and treating digestive health conditions. We take time to get to know each patient, develop a personalized, whole-person care plan that includes identification of symptom triggers and prescription of evidence-based interventions, including medications, dietary changes, and mental health support.
For Every Oshi Team Member We Want:
- Genuine passion for improving patient lives and transforming GI care
- Strong communication skills and emotional intelligence
- Comfort in a fast-paced, remote-first, mission-driven environment
Note: This job description serves as a general overview and may be subject to change based on organizational needs and requirements.
Oshi Health is an equal opportunity employer that is committed to creating a diverse work environment. To do that, we champion a workplace where each and every person is treated with dignity and respect and is valued for their unique perspective and contributions.
Oshi Health's policy is to maintain a working environment that encourages mutual respect, promotes harmonious and congenial relationships between employees, and is free from all forms of discrimination and harassment of any employee (or applicant for employment or service provider) by anyone, including supervisors, co-workers, vendors, or clients. Harassment and discrimination in any manner or form is expressly prohibited. There is no tolerance for discrimination or unequal treatment of any kind on the basis of race, color, religion, creed, gender, sex, sexual orientation, gender identity or expression, pregnancy, sexual and reproductive health decisions, national origin, age, disability, genetic information, marital status or civil partnership/union status, familial status, military or veteran status, predisposition or carrier status, domestic violence victim status, alienage or citizenship status, unemployment status, sexual violence or stalking victim status, caregiver status, or any other characteristic protected by law.
This practice applies to all terms, conditions and privileges of employment including, but not limited to, recruitment, selection, promotion, demotion, transfer, layoff, rehire, termination of employment, development and training, compensation, benefits and retirement.
For more information, visit us at www.oshihealth.com
Oshi Health will never contact job candidates via text message or any other messaging platform including WhatsApp, Signal, and Telegram. All official correspondence will occur through email. We will never ask you to share bank account information, cash a check from us, or purchase software or equipment as part of your interview or hiring process. If you have concerns, please reach out to [email protected], and we'll confirm whether you're engaging with one of our Oshi teammates!
