RCM Insurance (Benefits) Verification Advisor (23655)

Location: 2537 Golden Bear Dr, Carrollton, TX 75006

Schedule: Full time

Reports to: Director of Accounts Receivable

What We Offer You

• Competitive pay

• Performance‑based bonus opportunities

• Comprehensive health, dental, and vision insurance

• Additional supplemental benefits (life insurance, disability, accident, etc.)

• 401(k) with company match

• Generous paid time off (PTO/Sick)

• Clear career growth and advancement opportunities

• A supportive and vibrant company culture

• Many more employee perks and benefits

Job Summary

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.

#Corp