Insurance Verification Call Center

This is a fully remote position, open to applicants in Texas.

📋 Description

• Conduct investigations and confirm patient medical and prescription insurance benefits.

• Manage and track prior authorizations and appeals to facilitate medication access.

• Relay referral and authorization updates to patients, healthcare providers, and insurance companies through phone, fax, and electronic systems.

• Support provider offices throughout the prior authorization and appeal submission processes.

• Work collaboratively with insurance payers, healthcare providers, and internal teams to gather accurate coverage details.

• Record interactions and insurance data meticulously within company systems.

• Recognize and communicate alternative funding and financial assistance options for patients.

• Assess benefit verification information for precision and identify when further investigation is warranted.

• Elevate complex matters to management when necessary.

• Ensure compliance with HIPAA, federal and state regulations, and company policies.

• Input and update patient demographic and insurance data.

• Identify and report potential adverse events in line with FDA and company guidelines.

• Achieve or surpass quality, productivity, and performance metrics.

• Engage in continual training, process enhancements, and special projects as assigned.

⛳️ Requirements

• A minimum of 13 years of experience in healthcare, insurance, reimbursement, pharmacy, or customer service sectors.

• Prior experience in a call center, healthcare office, insurance provider, pharmacy, or corporate environment.

• Exceptional customer service and communication abilities.

• Capable of handling multiple tasks while ensuring accuracy and attention to detail.

• Proficient in Microsoft Office and quick to learn new software systems.

• Strong problem-solving and organizational capabilities.

• Access to a secure and private working environment.

• Experience in a pharmacy call center is preferred.

• Background in a healthcare call center is preferred.

• Familiarity with medical claims processing is preferred.

• Experience in insurance verification is preferred.

• Knowledge of commercial and government insurance programs is preferred.

• Understanding of prior authorizations, appeals, reimbursement processes, and specialty pharmacy operations is preferred.

🏝️ Benefits

• Medical, dental, and vision coverage.

• Critical Illness, Accident, and Hospital insurance.

• 401(k) Retirement Plan with pre-tax and Roth post-tax contributions.

• Voluntary Life & AD&D insurance available for employees and their dependents.

• Short-term and long-term disability coverage.

• Health Spending Account (HSA).

• Transportation benefits.

• Employee Assistance Program.

• Paid Time Off/Leave (PTO, Vacation, or Sick Leave).