Remote Prior Authorization & Insurance Specialist

TEKsystems; Minneapolis (MN); Remote; USD 23,000 - 32,000; Full time

Benefits offered by this job

Medical, dental & vision

401(k) Retirement Plan

PTO/Vacation or Sick Leave

Health Spending Account (HSA)

Job summary

TEKsystems, a nationwide IT and talent solutions leader, offers a fully remote contract role for an insurance billing claims processing and prior authorizations expert. The position focuses on liaison between departments, payors and providers to determine patient prescription coverage.

Responsibilities include handling prior authorizations, appeals filings, and verification through internal systems, while ensuring rapid turnaround and accurate documentation.

Qualifications

• 1-3 years of work experience in a healthcare or reimbursement setting.
• Previous experience in a call center environment, healthcare office, corporate setting, or healthcare insurance provider or pharmacy is required.
• Thorough understanding and knowledge of commercial and government pharmacy and medical insurance programs, billing, alternate funding resources, reimbursement processes, insurance verification, prior authorization and appeal filings, and specialty pharmacy operations.

Responsibilities

• Provide subject matter expertise on medical and prescription insurance coverage/ verification claim billing medication prior authorization and appeal filing.
• Accurately documents information in the appropriate systems and formats.
• Communicate the status of the referral to the physician and the patient via phone, fax, and/or the core pharmacy system.
• Assist offices through the documentation and filing process for prior authorizations and appeals; monitor status for rapid turnaround.
• Investigate pharmacy and medical benefits with payors and providers to maintain payor intelligenceResources.

Skills

Pharmacy call center experience

Healthcare call center experience

Medical claims experience

Insurance verification

Prior authorizations

Tools

Hub information system

Core pharmacy system

Job description

TEKsystems, a nationwide IT and talent solutions leader, offers a fully remote contract role for an insurance billing claims processing and prior authorizations expert. The position focuses on liaison between departments, payors and providers to determine patient prescription coverage.

Responsibilities include handling prior authorizations, appeals filings, and verification through internal systems, while ensuring rapid turnaround and accurate documentation.