Remote Payor Specialist — Medical Device Coverage

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

Benefits offered by this job

Employee Ownership Program

401(k) plan with employer matching

Paid time off

Home office benefits

Job summary

PRO-Spectus is seeking a Payor Specialist to verify and reverify insurance coverage, submit authorizations, and maintain ongoing communication with insurance providers.

Key duties include coordinating with Case Management, handling LOA/SCA requests, tracking payor determinations, and ensuring timely follow-up to support patient scheduling and care plans.

The role requires strong organizational skills, knowledge of payer guidelines, and proactive communication across EST to PST time zones.

Qualifications

• Experience with payers and Medical Policy preferred.
• Conversant with medical terminology.
• Expertise and knowledge of third‑party payor guidelines (e.g., Medicare/Medicaid).
• Computer and database management to handle proprietary systems.
• Interpersonal and communication skills for physicians, leaders, staff and patients.
• High school diploma with healthcare experience or associates degree with 3–4 years in healthcare.

Responsibilities

• Coordinate with Case Management to prioritize daily activities.
• Verify and reverifiy insurance benefits and eligibility.
• Update eligibility information based on verifications.
• Submit and follow up on authorization requests.
• Submit LOA/SCA and follow up through negotiation or final payor determination.
• Obtain payor determinations and communicate to the Case Management Team.
• Track payor requests for information and ensure timely responses.
• Document and convey outcomes and next steps to stakeholders.
• Communicate out-of-network obstacles and seek to improve in-network status.
• Provide feedback on payor guidelines and determinations.
• Ensure payor and customer satisfaction through effective communication.
• Follow up on pending payor correspondence for expedited turnaround.
• Interpret payor documentation for team and patient.
• Elevate/expedite review timelines as needed.
• Collaborate cross-functionally with management and programs.
• Additional duties as assigned.

Skills

Payer verification

Attention to detail

Communication

Multitasking

Healthcare policy

Negotiation

Documentation

Education

Associate's Degree in healthcare-related field

High school diploma with healthcare experience

Tools

EHR systems

Proprietary databases

Data management

Job description

PRO-Spectus is seeking a Payor Specialist to verify and reverify insurance coverage, submit authorizations, and maintain ongoing communication with insurance providers.

Key duties include coordinating with Case Management, handling LOA/SCA requests, tracking payor determinations, and ensuring timely follow-up to support patient scheduling and care plans.

The role requires strong organizational skills, knowledge of payer guidelines, and proactive communication across EST to PST time zones.