Benefit Verification Specialist

Benefit Verification Specialist

Remote-US (must reside within 60 miles of DFW)

Compensation & Schedule

• $18/hr

• Must be available Monday–Friday between 7:00 AM – 7:00 PM CST

• temporary project

• Start date: 12/2, expected to go through the end of March 2026

ROLE IMPACT

As a Benefit Verification Specialist, you will be the link between patients, providers, and insurance companies—helping patients access critical medications and devices. By securing prior authorizations and validating benefits, your work supports timely treatment for conditions that are often life-threatening, rare, or costly. You’ll leverage strong communication, documentation, and problem-solving skills to support billing teams and ensure insurance compliance.

KEY RESPONSIBILITIES

• Conduct outbound calls to payers and gather missing insurance data for benefit investigations

• Submit and track prior authorizations, ensuring complete and timely insurer documentation

• Assist provider offices and patients with insurance forms and program applications

• Maintain ongoing communication with payers, pharmacies, and provider representatives

• Report reimbursement delays or trends and escalate issues when necessary

• Coordinate with internal departments and document all case activity accurately

• Address customer inquiries and resolve service requests with urgency and accuracy

• Ensure all prior authorization materials meet compliance, including NPI, referrals, and patient demographics

• Identify and report adverse events (AEs) per SOP and training standards

MINIMUM QUALIFICATIONS

• High school diploma or GED required

• 1+ years' experience in specialty pharmacy, medical insurance, or healthcare setting

• Working knowledge of medical and pharmacy benefits, copay structures, and prior authorizations

• Familiarity with commercial and government payer systems preferred

• Strong communication, documentation, and negotiation skills

CORE TOOLS & SYSTEMS

• Microsoft Excel, Outlook, Word

• Insurance portals and EMR systems

• Document and case management platforms

• Phone systems and CRM/call tracking

PREFERRED SKILLS

• Certificate in medical billing and coding

• Experience in medical collections or reimbursement support

• Knowledge of HIPAA, patient assistance programs (PAP), and appeals workflows

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