Remote Benefits Verification Specialist

TalentLNX LLC; United States; Teletrabalho; USD 37 000 - 52 000; Tempo integral

Resumo da oferta

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.

Qualificações

• 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

Responsabilidades

• 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

Conhecimentos

Benefits verification

Prior authorization

Insurance verification

Patient access

Bilingual English/Spanish

Formação académica

High school diploma or equivalent

Associate or Bachelor's degree preferred

Ferramentas

Payer portals

Electronic health records

Prior authorization platforms

Descrição da oferta de emprego

We are seeking a Remote Benefits Verification Specialist to join a growing patient access team within a healthcare organization. In this role, you will verify insurance coverage, secure prior authorizations, and help patients understand their benefits, serving as a trusted resource so patients can start care without delay. This position is a full time, direct hire opportunity with a fully remote schedule. Hiring will begin as new openings launch, so we are connecting with qualified candidates now.

This role is well suited for a detail oriented healthcare professional who enjoys working with payers and helping patients get access to the care they need. Professionals from hospital, physician office, health plan, pharmacy, hub services, and healthcare call center backgrounds are encouraged to apply. The ideal candidate is organized, a clear communicator, and comfortable managing a steady volume of cases while staying accurate. Training on internal workflows, systems, and payer processes is provided.

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

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

Schedule:

• Full time, Direct Hire
• Monday through Friday, standard business hours
• 40 hours per week, 100% remote
• Reliable high speed internet and a private home workspace required for remote work

Salary Range:

The salary range for this position is approximately $37,440 to $52,000 annually ($18.00 to $25.00 per hour), based on experience and qualifications.

Interview Process:

Selected candidates will participate in a multi step interview process, including an initial screening with TalentLNX followed by interviews with department leadership.

Equal Opportunity Employer:

TalentLNX is committed to equal employment opportunity and a diverse, inclusive workforce. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, pregnancy, sexual orientation, gender identity, national origin, age, disability, genetic information, veteran status, or any other characteristic protected by applicable federal, state, or local law.