Remote Prior Authorization & Benefits Specialist

Job Title: Remote Prior Authorization & Benefits Specialist

Job Description

The Insurance Verification Coordinator obtains and verifies complete insurance information, manages prior authorization processes, and supports patients and providers by ensuring accurate coverage, benefits, and billing details. This role combines strong customer service with detailed benefits investigation and insurance coordination to help patients access therapies and services efficiently.

Responsibilities

• Obtain and verify insurance eligibility for all services provided and accurately document complete information in the system.
• Perform prior authorizations as required by each payor source, including gathering necessary documentation by collaborating with physician offices and insurance companies.
• Collect and record clinical information such as lab values, diagnosis codes, and other relevant medical data needed for authorization and billing.
• Determine patients’ financial responsibilities based on insurance coverage and clearly document these details.
• Configure and maintain coordination of benefits information for every referral to ensure accurate primary and secondary coverage.
• Ensure assignment of benefits forms are obtained, properly completed, and on file for Medicare claims.
• Bill insurance companies for therapies and services provided, following applicable billing guidelines and procedures.
• Document all pertinent communication with patients, physicians, and insurance companies, particularly as it relates to collection procedures and reimbursement.
• Identify and coordinate patient resources related to reimbursement, including copay cards, third-party assistance programs, and manufacturer assistance programs.
• Handle inbound calls from patients, physician offices, and insurance companies, providing clear, courteous, and timely information.
• Resolve claim rejections related to eligibility, coverage, and other issues by investigating discrepancies and taking corrective action.
• Utilize insurance terminology and medical terminology accurately when working with claims, benefits, and documentation.
• Perform accurate and timely data entry in all relevant systems to maintain complete and up-to-date records.

Essential Skills

• High school diploma.
• 1 years of medical billing or insurance verification experience; a bachelor’s degree in a related field may substitute for this experience.
• Experience working with payors and prior authorization processes (preferred).
• Basic knowledge of medical terminology and familiarity with diagnosis codes and clinical information.
• Competence in billing and coding processes related to healthcare services and therapies.
• Strong computer skills with the ability to perform accurate and efficient data entry.
• Healthcare experience in areas such as billing, coding, insurance verification, benefits investigation, or similar functions.

Additional Skills & Qualifications

• Bachelor’s degree in a related field, which can substitute for required experience.
• Military experience considered in lieu of or in addition to traditional work experience.
• Experience with Medicare and Medicaid claims and regulations.
• Familiarity with copay assistance programs, third-party assistance programs, and manufacturer assistance programs.
• Ability to collaborate effectively with physician offices and insurance companies.

Work Environment

This position operates in a 100% remote work environment, providing flexibility while maintaining a structured schedule. The standard shift is Monday through Friday from 11:00AM to 8:00 PM. All necessary equipment, including computer, monitor, keyboard, and mouse, is provided. Work is performed using computer-based systems and electronic documentation, with frequent phone and online communication with patients, physician offices, and insurance companies. The role requires a quiet, professional home workspace that supports confidential conversations and focused, detail-oriented work.

This is a Contract to Hire position based out of ORLANDO, FL.

The pay range for this position is $17.00 - $19.00/hr.

Eligibility requirements apply to some benefits and may depend on your job classification and length of employment. Benefits are subject to change and may be subject to specific elections, plan, or program terms. If eligible, the benefits available for this temporary role may include the following:
• Medical, dental & vision
• Critical Illness, Accident, and Hospital
• 401(k) Retirement Plan – Pre-tax and Roth post-tax contributions available
• Life Insurance (Voluntary Life & AD&D for the employee and dependents)
• Short and long-term disability
• Health Spending Account (HSA)
• Transportation benefits
• Employee Assistance Program
• Time Off/Leave (PTO, Vacation or Sick Leave)

This is a fully remote position.

This position is anticipated to close on Jun 3, 2026.

About Actalent

Actalent is a global leader in engineering and sciences services and talent solutions. We help visionary companies advance their engineering and science initiatives through access to specialized experts who drive scale, innovation and speed to market. With a network of almost 30,000 consultants and more than 4,500 clients across the U.S., Canada, Asia and Europe, Actalent serves many of the Fortune 500.

The company is an equal opportunity employer and will consider all applications without regard to race, sex, age, color, religion, national origin, veteran status, disability, sexual orientation, gender identity, genetic information or any characteristic protected by law.

If you would like to request a reasonable accommodation, such as the modification or adjustment of the job application process or interviewing process due to a disability, please email actalentaccommodation@actalentservices.com for other accommodation options.

San Francisco Fair Chance Ordinance: Pursuant to the San Francisco Fair Chance Ordinance, for all positions located in the city and county of San Francisco, we will consider for employment qualified applicants with arrest and conviction records.

Massachusetts Lie Detector: It is unlawful in Massachusetts to require or administer a lie detector test as a condition of employment or continued employment. An employer who violates this law shall be subject to criminal penalties and civil liability.

Use of Artificial Intelligence (AI): We may use Artificial Intelligence (AI) to support parts of our hiring process, including sourcing, screening, and evaluating candidates. AI helps assess applications and qualifications, but final decisions are made by our hiring team. By applying, you acknowledge and agree that your application may be reviewed using AI tools.

Salary : $17 - $19