Insurance/Prior Authorization Specialist - Remote

TEKsystems • Minneapolis, MN

2d • $20 - $20 • Remote

About The Position

This remote, 1+ year contract position is a subject matter expert role in insurance billing, claims processing, and prior authorizations. The specialist liaises among departments, payors, providers, and patients to determine overall prescription coverage. The role pays $20 per hour and is based out of Minneapolis, Minnesota.

The specialist provides expertise on medical and prescription insurance coverage and verification, claim billing, medication prior authorizations, appeals, and alternative financial assistance opportunities. The role also supports offices through prior authorization and appeal documentation and filing, monitors referral status to help ensure timely access to medications, investigates pharmacy and medical benefits using internal and web tools, maintains payor intelligence resources, and enters patient demographic and insurance information into the hub information system.

The position is fully remote. The posting notes that benefits may be available to eligible temporary-role employees, depending on job classification, length of employment, and applicable plan terms.

Requirements

• 1–3 years of work experience in a healthcare or reimbursement setting.
• Previous experience in a call center environment, healthcare office, corporate setting, healthcare insurance provider, or pharmacy.
• Thorough understanding of commercial and government pharmacy and medical insurance programs, billing, alternative funding resources, reimbursement processes, insurance verification, prior authorization and appeal filings, and specialty pharmacy operations.

Nice To Haves

• Pharmacy call center experience (A+ candidate).
• Healthcare call center and medical claims experience (A- candidate).

Responsibilities

• Provide subject matter expertise on medical and prescription insurance coverage and verification, claim billing, medication prior authorizations, appeal filing, and alternative financial assistance opportunities.
• Accurately document information in appropriate systems and formats.
• Communicate referral status to physicians and patients by phone, fax, and/or the core pharmacy system, following established policies and procedures.
• Assist offices with the documentation and filing process for prior authorizations and appeals.
• Monitor prior authorization and appeal status to support rapid turnaround and procurement of drug products for patients.
• Use internal and web tools, and collaborate with health insurance payors and providers, to investigate pharmacy and medical benefits.
• Obtain and confirm information to maintain Pharmacy Solutions payor intelligence resources.
• Enter patient demographic and health insurance information into the hub information system.
• Notify physicians of incomplete or incorrect insurance information.

Benefits

• Medical, dental, and vision coverage, if eligible.
• Critical illness, accident, and hospital coverage, if eligible.
• 401(k) retirement plan with pre-tax and Roth post-tax contributions available, if eligible.
• Voluntary life and AD&D insurance for employees and dependents, if eligible.
• Short- and long-term disability coverage, if eligible.
• Health Spending Account (HSA), if eligible.
• Transportation benefits, if eligible.
• Employee Assistance Program, if eligible.
• Time off or leave, which may include PTO, vacation, or sick leave, if eligible.

What This Job Offers

• Job Type: Full-time
• Career Level: Entry Level
• Education Level: No Education Listed