Insurance Verification Specialist

TEKsystems • Baltimore, MD

1d • $20 - $23 • Remote

About The Position

TEKsystems is hiring a fully remote Medical Insurance Specialist who must work in the Eastern Time Zone. This contract-to-hire role supports patients and providers by confirming eligibility and completing referrals, pre-certifications, and authorizations before services are provided, helping ensure a positive experience and mitigate denials.

The specialist reviews scheduled procedures and provider schedules, verifies insurance information and managed-care requirements, contacts insurers about eligibility and benefits, and obtains required authorizations. They enter authorization and billing data into the relevant systems, monitor authorization work queues, follow up with payers and providers, and communicate about missing documentation or scheduling changes. The role also requires keeping current with authorization regulations and requirements, meeting performance and quality benchmarks, participating in training and workgroups, and protecting patient confidentiality.

Requirements

• 2–5 years of healthcare insurance verification experience.
• Experience with high-volume healthcare insurance verification and understanding different insurance plans.
• Working knowledge and demonstrated proficiency in payer authorization and clearance processes.
• Basic working knowledge of UB04, HCFA 1500 or equivalent, and payer responses.
• Some knowledge of medical terminology and CPT/IDC-9 coding.
• Excellent communication, analytical, interpersonal, and organizational skills.
• Proficiency with hospital registration and/or billing systems, personal computers, Microsoft Excel, and Microsoft Word.
• Ability to type 35 WPM.
• Must work in the Eastern Time Zone.

Nice To Haves

• Experience with EPIC.
• Authorization experience.

Responsibilities

• Verify patient eligibility and compliance with departmental and managed-care requirements and contracts.
• Obtain insurance referrals and pre-authorizations for scheduled procedures, admissions, medications, and medical equipment.
• Review scheduled procedures and provider schedules, confirm insurance information, and check related documentation for completeness.
• Communicate with insurance companies to determine benefit eligibility and deductible status and obtain required precertifications.
• Respond efficiently to inquiries from patients, providers, and hospital staff about authorizations and scheduling.
• Enter authorization and other relevant data in IDX, SMS/Invision, and required appointment or authorization fields to support accurate billing.
• Obtain missing authorization or precertification numbers and communicate when appointments may need to be rescheduled because required information is missing.
• Monitor and complete the MedConnect Pre-Authorization Work Queue, maintain accurate authorization status, and coordinate with provider staff about requirements such as additional documentation or peer-to-peer requests.
• Maintain current knowledge of regulatory and other changes affecting pre-authorization and pre-certification requirements.
• Meet daily performance benchmarks and departmental quality assurance standards, including follow-up with payers and assigned providers.
• Attend required training, complete continuing education and annual mandatory training, and participate in workgroups, staff meetings, work events, and quality or service improvement teams.
• Maintain professional and effective communication and protect the confidentiality of patient information.

Benefits

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

What This Job Offers

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