Benefits Investigation & Eligibility Specialist (Genetics)

Location: Remote — United States

Company

hirify.global provides genetic and molecular diagnostic testing services.

What you will do

• Verify primary, secondary, and tertiary insurance coverage, member details, effective dates, plan types, and coordination-of-benefits requirements.
• Use payer portals, electronic eligibility tools, and direct payer contact to resolve inactive, incomplete, incorrect, or conflicting insurance information.
• Investigate benefits for genetic and molecular diagnostic services, including deductibles, copayments, coinsurance, network requirements, and benefit limitations.
• Identify prior authorization, notification, referral, medical records, and other payer requirements, then route cases with complete supporting information.
• Communicate findings with patients, provider offices, payers, and internal teams while managing work queues and meeting turnaround, productivity, and quality expectations.
• Maintain accurate, auditable documentation and follow HIPAA, company policies, and payer and regulatory requirements.

Requirements

• High school diploma or equivalent.
• 2+ years of experience in healthcare insurance verification, benefits investigation, patient access, revenue cycle, or a related function.
• Working knowledge of commercial insurance, Medicare, Medicaid, and managed care plans.
• Experience with payer portals, electronic eligibility tools, and healthcare or revenue cycle systems.
• Strong problem-solving, documentation, communication, prioritization, and independent work skills.
• Ability to handle protected health information and confidential financial information appropriately.

Nice to have

• Associate degree in healthcare administration, business, or a related field.
• Experience in diagnostic laboratory, genetics, molecular diagnostics, pathology, or specialty healthcare.
• Experience with Quadax, Salesforce, clearinghouses, payer portals, or similar systems.
• Familiarity with prior authorization workflows, payer medical policies, and patient financial responsibility.

Culture & Benefits

• Remote, computer- and telephone-based work environment.
• Regular interaction with patients, provider offices, payers, and internal operational teams.
• Training, quality reviews, and opportunities to improve workflows.
• Inclusive equal-opportunity workplace with reasonable accommodations provided as required by law.