Continued Qualifications Specialist

TEKsystems•Whitpain Township, PA

6d•$22 - $24•Onsite

About The Position

We are seeking a detail-oriented and customer-focused Continued Qualifications Specialist to join our growing healthcare operations team in Blue Bell, PA. In this role, you will help ensure patients receiving home-based therapy continue to meet insurance and coverage requirements, allowing them to maintain uninterrupted access to care. This is an excellent opportunity for someone with experience in healthcare insurance verification, authorizations, patient access, medical billing, or reimbursement who enjoys problem-solving, working directly with patients and providers, and making a meaningful impact on patient outcomes.

Requirements

Experience in insurance verification, authorizations, healthcare administration, medical billing, reimbursement, patient access, or a related healthcare setting.
Strong understanding of insurance processes and documentation requirements.
Ability to communicate effectively with patients, providers, and insurance representatives.
Excellent organizational skills and attention to detail.
Strong problem-solving and critical thinking abilities.
Ability to prioritize multiple tasks and meet deadlines in a fast-paced environment.
Proficiency with healthcare systems and documentation management.
Commitment to delivering exceptional customer service.

Nice To Haves

Highly organized and thrives in a detail-driven environment.
Enjoys solving complex insurance and authorization challenges.
Takes ownership of work and follows through on critical tasks.
Collaborative, proactive, and dependable team player.
Strong relationship-building skills with patients, providers, insurance representatives, and internal teams.
Passionate about helping patients maintain access to the care they need.

Responsibilities

Serve as a primary point of contact for patients, healthcare providers, insurance carriers, and internal teams.
Contact patients to verify ongoing therapy usage, insurance coverage, and provider information.
Obtain and manage medical documentation required to support continued insurance coverage and authorization.
Review patient eligibility based on payer guidelines, clinical requirements, and coverage limitations.
Manage insurance reauthorization activities and ensure timely submission of required documentation.
Maintain accurate records of patient information, authorizations, insurance details, and communication activities.
Partner with billing and reimbursement teams to support accurate and timely claims processing.
Investigate and resolve insurance-related issues, including authorization delays and denials.
Escalate concerns that may impact patient care, reimbursement, or claim submission timelines.
Ensure compliance with HIPAA, payer requirements, and healthcare regulations.
Identify opportunities to improve workflows and contribute to operational excellence initiatives.