Eligibility & Benefits Specialist (RCM)

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.

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