Benefits Verification Specialist

TEKsystems•Charlotte, NC

3d•$23 - $23•Remote

About The Position

This role involves managing inbound and outbound communications with healthcare providers, physician offices, specialty pharmacies, and health insurance plans to gather information on patient insurance benefits and coverage details. The specialist will verify patients' medical and pharmacy insurance benefits, including eligibility, coverage limitations, copayments, deductibles, coinsurance, and out-of-pocket responsibilities. Responsibilities include conducting outreach to obtain necessary documentation, benefit verifications, and prior authorizations, as well as reviewing patient cases to assess insurance requirements and identify any additional actions needed for treatment access. The role also entails coordinating and tracking prior authorizations, appeals, referrals, and other reimbursement-related activities, documenting all interactions and case updates in the appropriate systems, identifying and escalating coverage gaps or denials, and scheduling follow-up activities. Maintaining compliance with HIPAA regulations and company policies is crucial.

Requirements

HS Diploma/GED Equivalent
2+ years of healthcare call center experience
2+ years experience with insurance verification
health insurance
Customer service
Health care
Call center
patient access
benefits verification

Responsibilities

Manage inbound and outbound communications with healthcare providers, physician offices, specialty pharmacies, and health insurance plans regarding patient insurance benefits and coverage details.
Verify patients' medical and pharmacy insurance benefits, including eligibility, coverage limitations, copayments, deductibles, coinsurance, and out-of-pocket responsibilities.
Conduct outreach to providers, insurance carriers, and other stakeholders to obtain required documentation, benefit verifications, and prior authorizations.
Review patient cases and accurately assess insurance requirements, identifying any additional actions needed to facilitate access to treatment or services.
Coordinate and track prior authorizations, appeals, referrals, and other reimbursement-related activities to ensure timely resolution.
Document all interactions, benefit information, authorization statuses, and case updates in the appropriate systems.
Identify coverage gaps, insurance denials, or reimbursement barriers and escalate issues as necessary.
Schedule or coordinate follow-up activities, including provider outreach, patient communication, and appointment-related insurance requirements.
Maintain compliance with HIPAA regulations and company policies when handling protected health information.