Remote Insurance Verification Specialist

Actalent; Phoenix (AZ); Remote; USD 22,000 - 31,000; Full time

Benefits offered by this job

Medical benefits

Dental benefits

401(k) plan

Remote-friendly

Job summary

Actalent is seeking an Insurance Verification Coordinator in Phoenix, AZ to verify eligibility, obtain prior authorizations, and support patients, providers, and payors. The role involves extensive documentation, accurate benefits investigations, and timely communication to ensure coverage for prescribed therapies.

The position requires at least 1 year in medical billing or insurance verification or a related degree.

Qualifications

• At least 1 year of medical billing or insurance verification experience, or a bachelors degree in a related field as a substitute for experience.
• Hands-on experience obtaining insurance benefits directly from health plans and clearly communicating those benefits to patients.
• Experience submitting prior authorizations directly to payors, including gathering clinical documentation and following up as needed.
• Knowledge of insurance verification, benefit verification, and coordination of benefits processes.
• Familiarity with working with various insurance companies and payors, including Medicare and commercial plans.
• Proficiency with data entry and electronic systems for documenting eligibility, benefits, and communication.
• Strong customer service skills, with the ability to communicate professionally and empathetically with patients, providers, and insurance representatives.
• Ability to handle a high volume of referrals while maintaining at least 95% quality or higher.
• Strong attention to detail and accuracy when reviewing benefits, entering data, and documenting interactions.
• Ability to troubleshoot and resolve issues related to eligibility, coverage, and claim rejections.

Responsibilities

• Obtain and verify insurance eligibility and benefits for services and medications, and document complete and accurate information in the system.
• Perform prior authorizations as required by each payor, including gathering and submitting all necessary documentation by collaborating with physician offices and insurance companies.
• Collect and record relevant clinical information, such as lab values and diagnosis codes, to support coverage and authorization decisions.
• Determine each patients financial responsibility based on insurance coverage, including copays, coinsurance, and deductibles.
• Configure and maintain coordination of benefits information on every referral to ensure correct primary and secondary billing.
• Ensure assignments of benefits are obtained and on file for Medicare claims, in alignment with payor requirements.
• Communicate with insurance companies regarding therapies provided, including benefit clarification, coverage issues, and claim-related questions.
• Document all pertinent communication with patients, physicians, and insurance companies, particularly as it relates to reimbursement and collection procedures.
• Identify and coordinate patient financial assistance resources, including copay cards, third-party assistance programs, and manufacturer assistance programs.
• Handle inbound calls from patients, physician offices, and insurance companies, providing clear, courteous, and accurate information.
• Research and resolve claim rejections related to eligibility, coverage, and other insurance issues, escalating as needed.
• Work from an internal referral queue, processing a high volume of referrals each day while maintaining accuracy and timeliness.
• Meet or exceed established performance metrics, including daily referral volumes and quality standards.
• Maintain strong attendance and reliability to support consistent patient and provider service.

Skills

Medical billing

Insurance verification

Prior authorizations

Coordination of benefits

Medicare plans

Data entry

Customer service

Detail oriented

Communication skills

Education

High school diploma

Bachelor's degree preferred

Job description

Actalent is seeking an Insurance Verification Coordinator in Phoenix, AZ to verify eligibility, obtain prior authorizations, and support patients, providers, and payors. The role involves extensive documentation, accurate benefits investigations, and timely communication to ensure coverage for prescribed therapies.

The position requires at least 1 year in medical billing or insurance verification or a related degree.