Remote Payor Specialist: Insurance Verifications

PRO-spectus; United States; Remote; USD 41,000 - 56,000; Full time

Benefits offered by this job

Employee Ownership Program

Home office benefits

401(k) with employer matching

Paid time off

Job summary

PRO-Spectus is seeking a Payor Specialist to verify and reverify patient insurance coverage and eligibility, submit authorization requests, and maintain proactive communication with insurance companies. Remote work from home is supported in a dynamic healthcare setting.

You will coordinate with Case Management, manage LOA/SCA requests, and ensure timely payor determinations while documenting outcomes for the team.

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.

Responsibilities

• Verifies and reverifies insurance coverage and eligibility.
• Submits and follows up on authorization requests and LOA/SCA.
• Communicates payor determinations to the Case Management Team.
• Tracks payor information and ensures compliance with requests.
• Documents outcomes and next steps to payor and case management teams.

Skills

Organizational skills

Attention to detail

Effective communication

Insurance terminology

Payor guidelines knowledge

Adaptability

Self-motivation

Education

High school diploma with healthcare experience or associate degree in healthcare-related field

Job description

PRO-Spectus is seeking a Payor Specialist to verify and reverify patient insurance coverage and eligibility, submit authorization requests, and maintain proactive communication with insurance companies. Remote work from home is supported in a dynamic healthcare setting.

You will coordinate with Case Management, manage LOA/SCA requests, and ensure timely payor determinations while documenting outcomes for the team.