Benefits Verification Specialist

TEKsystems•Tampa, FL

1d•$23 - $23•Onsite

About The Position

This role involves managing communications with healthcare providers, physician offices, specialty pharmacies, and health insurance plans to verify patient insurance benefits and coverage details. The specialist will conduct outreach to obtain necessary documentation, verify benefits, and secure prior authorizations. A key part of the role is reviewing patient cases, assessing insurance requirements, and identifying any additional actions needed to facilitate treatment access. The specialist will also coordinate and track prior authorizations, appeals, and referrals, documenting all interactions and case updates in the system. Identifying coverage gaps, denials, or reimbursement barriers and escalating issues are also responsibilities. The role requires scheduling and coordinating follow-up activities, including provider outreach and patient communication, while maintaining strict compliance with HIPAA regulations and company policies regarding protected health information.

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.