Remote Payor Specialist: Insurance Verifications

PRO-Spectus; Northern (KY); Hybrid; USD 41,000 - 56,000; Full time

Benefits offered by this job

Medical benefits

Home office stipend

Job summary

PRO‑Spectus is seeking a Payor Specialist to verify and reverify patient insurance coverage, submit authorizations, LOA/SCA requests, and maintain ongoing communication with payors. The role supports a remote-first team and coordinates with Case Management to meet deadlines and ensure accurate eligibility data.

The position emphasizes timely payor determinations, effective follow-up, and collaboration across programs to optimize in-network benefits and patient outcomes.

Qualifications

• Experience with payers and Clinical Guidelines or Medical Policy is preferred.
• Conversant with medical terminology.
• Expertise and knowledge of third‑party payor, Medicare/Medicaid guidelines.
• Computer and database management skills to efficiently and effectively manage proprietary electronic systems.
• Interpersonal and communication skills to deal with physicians, hospital leaders, nursing staff, patients, and family members.
• High school diploma with healthcare experience or Associate's Degree with three to four years of experience.

Responsibilities

• Works directly with Case Management Team to coordinate efforts and prioritize daily activities.
• Completes insurance benefits verification and reverification to confirm active coverage and payor requirements.
• Updates eligibility information accurately and timely based on payor verification findings.
• Submits authorization requests and performs timely follow-up through final payor determination.
• Submits LOA and SCA requests and follows up through rate negotiation or final payor determination.
• Obtains payor determinations and records and conveys them to the Case Management Team.

Skills

Insurance verification

Attention to detail

Communication skills

Organizational skills

Payor guidelines

Education

High school diploma + healthcare experience

Associate's Degree in healthcare

Tools

EHR systems

Job description

PRO‑Spectus is seeking a Payor Specialist to verify and reverify patient insurance coverage, submit authorizations, LOA/SCA requests, and maintain ongoing communication with payors. The role supports a remote-first team and coordinates with Case Management to meet deadlines and ensure accurate eligibility data.

The position emphasizes timely payor determinations, effective follow-up, and collaboration across programs to optimize in-network benefits and patient outcomes.