We are seeking a Remote Benefits Verification Specialist to join a growing patient access team within a healthcare organization. In this role, you will verify insurance coverage, secure prior authorizations, and help patients understand their benefits, serving as a trusted resource so patients can start care without delay.
This position is a full time, direct hire opportunity with a fully remote schedule. Hiring will begin as new openings launch, so we are connecting with qualified candidates now.
This role is well suited for a detail oriented healthcare professional who enjoys working with payers and helping patients get access to the care they need. Professionals from hospital, physician office, health plan, pharmacy, hub services, and healthcare call center backgrounds are encouraged to apply. The ideal candidate is organized, a clear communicator, and comfortable managing a steady volume of cases while staying accurate.
Training on internal workflows, systems, and payer processes is provided.
Responsibilities:
Verify patient eligibility and benefits through payer portals and calls to insurance companies
Review medical and pharmacy benefits for commercial, Medicare, Medicaid, and managed care plans
Determine whether therapies are covered under the medical or pharmacy benefit and identify any coverage restrictions
Document coverage details, including deductibles, copays, coinsurance, out of pocket maximums, and authorization requirements
Submit and track prior authorizations, following up with payers until a decision is made
Gather clinical documentation from provider offices, such as diagnosis codes, office notes, and lab results
Support appeals and reconsiderations for denied authorizations by coordinating needed documentation with providers
Confirm primary and secondary coverage for each patient and coordinate benefits when more than one plan applies
Complete benefit reverifications when coverage changes, plans renew, or authorizations near expiration
Explain coverage, estimated costs, and next steps to patients and caregivers clearly and with empathy
Refer patients to financial assistance options, such as copay programs and foundation support, when they qualify
Communicate case status and coverage outcomes to providers, pharmacy teams, and internal partners
Escalate complex cases or payer issues to leadership in a timely manner
Meet established turnaround times and quality standards for each case
Maintain accurate records in the system and follow HIPAA guidelines at all times
Qualifications:
High school diploma or equivalent; associate or bachelor's degree preferred
2+ years of benefits verification, prior authorization, insurance verification, or patient access experience
Experience in a hospital, physician office, health plan, pharmacy, hub services, or healthcare call center
Working knowledge of commercial, Medicare, Medicaid, and managed care coverage
Understanding of medical and pharmacy benefit structures, including deductibles, coinsurance, and out of pocket costs
Familiarity with ICD 10, CPT, and HCPCS codes
Experience with payer portals, electronic health records, and prior authorization platforms preferred
Specialty pharmacy or specialty medication experience preferred
Strong phone presence and the ability to explain coverage in plain language
Ability to manage a steady volume of cases while maintaining accuracy and meeting deadlines
Proficiency with Microsoft Office and comfort learning new systems
Bilingual in English and Spanish a plus
Schedule:
Full time, Direct Hire
Monday through Friday, standard business hours
40 hours per week, 100% remote
Reliable high speed internet and a private home workspace required for remote work
Salary Range:
The salary range for this position is approximately $37,440 to $52,000 annually ($18.00 to $25.00 per hour), based on experience and qualifications.
Interview Process:
Selected candidates will participate in a multi step interview process, including an initial screening with TalentLNX followed by interviews with department leadership.
Equal Opportunity Employer:
TalentLNX is committed to equal employment opportunity and a diverse, inclusive workforce. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, pregnancy, sexual orientation, gender identity, national origin, age, disability, genetic information, veteran status, or any other characteristic protected by applicable federal, state, or local law.