Remote Benefits Verification & Access Specialist

TalentLNX LLC; United States; Remote; USD 37,000 - 52,000; Full time

Job summary

TalentLNX LLC is seeking a Remote Benefits Verification Specialist to support patient access by verifying eligibility and benefits, securing prior authorizations, and guiding patients through coverage options. This is a full-time, direct-hire role with a fully remote schedule.

The ideal candidate has 2+ years of benefits verification or related experience, strong communication skills, and proficiency with payer portals and electronic health records.

Qualifications

• High school diploma or equivalent; associate or bachelor's degree preferred
• 2+ years of benefits verification, prior authorization, insurance verification, or patient access experience
• Experience in a hospital, physician office, health plan, pharmacy, hub services, or healthcare call center
• Working knowledge of commercial, Medicare, Medicaid, and managed care coverage
• Understanding of medical and pharmacy benefit structures, including deductibles, coinsurance, and out of pocket costs
• Familiarity with ICD 10, CPT, and HCPCS codes
• Experience with payer portals, electronic health records, and prior authorization platforms preferred
• Specialty pharmacy or specialty medication experience preferred
• Strong phone presence and the ability to explain coverage in plain language
• Ability to manage a steady volume of cases while maintaining accuracy and meeting deadlines
• Proficiency with Microsoft Office and comfort learning new systems
• Bilingual in English and Spanish a plus

Responsibilities

• Verify patient eligibility and benefits through payer portals and calls to insurance companies
• Review medical and pharmacy benefits for commercial, Medicare, Medicaid, and managed care plans
• Determine whether therapies are covered under the medical or pharmacy benefit and identify any coverage restrictions
• Document coverage details, including deductibles, copays, coinsurance, out of pocket maximums, and authorization requirements
• Submit and track prior authorizations, following up with payers until a decision is made
• Gather clinical documentation from provider offices, such as diagnosis codes, office notes, and lab results
• Support appeals and reconsiderations for denied authorizations by coordinating needed documentation with providers
• Confirm primary and secondary coverage for each patient and coordinate benefits when more than one plan applies
• Complete benefit reverifications when coverage changes, plans renew, or authorizations near expiration
• Explain coverage, estimated costs, and next steps to patients and caregivers clearly and with empathy
• Refer patients to financial assistance options, such as copay programs and foundation support, when they qualify
• Communicate case status and coverage outcomes to providers, pharmacy teams, and internal partners
• Escalate complex cases or payer issues to leadership in a timely manner
• Meet established turnaround times and quality standards for each case
• Maintain accurate records in the system and follow HIPAA guidelines at all times

Skills

Benefits verification

Prior authorization

Insurance verification

Patient access

Bilingual English/Spanish

Education

High school diploma or equivalent

Associate or Bachelor's degree preferred

Tools

Payer portals

Electronic health records

Prior authorization platforms

Job description

TalentLNX LLC is seeking a Remote Benefits Verification Specialist to support patient access by verifying eligibility and benefits, securing prior authorizations, and guiding patients through coverage options. This is a full-time, direct-hire role with a fully remote schedule.

The ideal candidate has 2+ years of benefits verification or related experience, strong communication skills, and proficiency with payer portals and electronic health records.