Healthcare Payor Change/ Reverification Representative

This position is posted by Jobgether on behalf of a partner company. We are currently looking for a Healthcare Payor Change/Reverification Representative in the United States.

This role plays a key part in ensuring accurate reimbursement and revenue integrity within a healthcare revenue cycle environment. You will be responsible for reviewing patient admissions, discharges, and supporting documentation to confirm that payer requirements are met and payments are properly recognized. Working closely with site leadership, nursing facilities, and accounts receivable teams, you will help prevent revenue leakage through timely verification, documentation review, and issue resolution. The position requires strong attention to detail, a solid understanding of payer rules, and the ability to manage multiple data-driven workflows. Operating in a fast-paced, remote-friendly healthcare setting, you will contribute directly to financial accuracy and compliance across Medicare, Medicaid, and commercial payer systems.

Accountabilities

You will be responsible for ensuring accurate reimbursement processes and maintaining compliance with payer and regulatory requirements across multiple healthcare sites:

• Perform daily audits of admission, discharge, and source documentation to ensure proper revenue recognition and compliance with payment conditions.
• Monitor and review Medicare and non-Medicare reverification cycles to ensure accuracy in billing and eligibility.
• Verify patient insurance eligibility and payer coverage details to support timely and accurate claims processing.
• Identify and resolve billing issues such as batch errors, bill holds, and missing documentation affecting revenue.
• Generate weekly revenue reports and communicate outstanding documentation issues to site leadership.
• Prepare and submit invoices to Accounts Payable and conduct follow-ups to ensure timely reimbursement.
• Coordinate documentation review for Medicare, Medicaid, and commercial payer requirements to support clean claims submission.
• Ensure internal controls, payer requirements, and compliance standards are consistently followed.
• Serve as a liaison between sites, facilities, and AR teams to maintain smooth revenue cycle operations.
• Support team continuity by assisting with workload coverage and ensuring timely completion of tasks during absences.

Requirements

The ideal candidate brings experience in healthcare revenue cycle processes, strong analytical ability, and a detail-oriented approach to compliance and documentation:

• 1+ years of experience in accounts receivable, insurance claims, eligibility verification, or related healthcare revenue cycle functions.
• Strong understanding of insurance verification, payer guidelines, and reimbursement workflows.
• Proficiency with Microsoft Office tools including Word, Excel, Outlook, and Teams.
• Ability to interpret payer requirements such as pre-certification, authorization, and level-of-care documentation.
• Strong organizational skills with the ability to manage multiple workflows and deadlines.
• Excellent attention to detail and accuracy in data review and documentation.
• Effective communication skills for collaborating with healthcare sites and internal teams.
• Preferred: Associate degree or additional experience in payer alignment or reverification processes.
• Ability to work independently in a remote environment with secure handling of PHI/HIPAA information.

Benefits

• Annual salary range: $43,000 – $56,200
• Comprehensive medical, dental, and vision insurance
• 401(k) retirement savings plan
• Paid time off, holidays, volunteer time off, and parental/caregiver leave
• Short-term and long-term disability coverage
• Life insurance benefits
• Remote work with equipment support provided by employer
• Internet reimbursement (for eligible home-based employees in select states)
• Employee wellness and whole-person health support programs
• Opportunities to work in a mission-driven healthcare environment focused on patient-centered care

How Jobgether works: We use an AI-powered matching process to ensure your application is reviewed quickly, objectively, and fairly against the role's core requirements. Our system identifies the top-fitting candidates, and this shortlist is then shared directly with the hiring company. The final decision and next steps (interviews, assessments) are managed by their internal team. We appreciate your interest and wish you the best! Why Apply Through Jobgether? Data Privacy Notice: By submitting your application, you acknowledge that Jobgether will process your personal data to evaluate your candidacy and share relevant information with the hiring employer. This processing is based on legitimate interest and pre-contractual measures under applicable data protection laws (including GDPR). You may exercise your rights (access, rectification, erasure, objection) at any time. #LI-CL1