JOB ID 20233 - Call Center Representative (Healthcare) 100+ Openings!
Title: Reimbursement Specialist

Location: Fully remote
Must be local to the Orlando/Lake Mary/surrounding areas to pick up and return equipment in Lake Mary, FL (ideally within 25 miles)

Pay: $17.00 per hour+ depending upon experience
$19.00 per hour for 2+ years of experience specific to healthcare benefits verification

Type: Contract, project role

Start date: Dec 2, 2024 (Will be assigned a tech enablement session week of Dec 2)
End date: Feb 15, 2024

Schedule: M-F, between the work hours of 8:00 AM to 8:00 PM EST (40 hours)
You will be assigned a schedule, with a (1) hour lunch, must adhere to assigned break schedules.
Weekends may be required starting in January (OT, volunteers first).
All overtime must be client approved.

Holidays: (Tentative days off) 12/24/24 –12/25/2024, 12/31/2024-1/1/2025

Training schedule: M-F, 9:00 AM to 6:00 PM EST during the month of December (on camera)
During training, you may not work a full (40) hour work week.

Quantity: 300

What is required if you’re interested:

• Position information session with Team Hiregy (face-to-face meeting).
• Candidate sign “Right to Represent” to work with Hiregy on the project.
• Position requirements checklist and action items issued to candidate.
• Candidate to complete Spark Hire one-way video interview.
• Hiring decision will be made off Spark Hire interview.
• If selected, successfully participate in, and complete all new hire requirements.
• If selected, pick up equipment in Lake Mary, FL.
• If selected, complete mandatory online pre-assignment links. (HIPAA, etc.).
• If selected, must successfully complete training (training is paid) by Dec 31.
• If selected, must return equipment in Lake Mary, FL.

Training:
Approximately (3) weeks of training. Training will consist of practice and mock calls.
There are various assessments during training, candidates must meet the program score requirements by Dec 31.
Days 5-7: Hands on, learning the CRM, specific client program protocol requirements. Must be familiar with cadence, script, how to navigate the system.

Role summary:
This role is heavy on calls and light on email communication.
This project is to reverify patient insurance benefits to ensure there are no lapses in coverage that could affect ongoing therapy. This involves checking current policy details and confirming that the patient's coverage remains active throughout their treatment period. This role ensures healthcare providers have up-to-date information about the patient’s insurance coverage to guarantee they will receive appropriate reimbursement for their services. This includes verifying network status and reimbursement rates. Confirm that all necessary prior authorizations are in place and valid. Ensure that any required documentation is submitted correctly, and that authorization remains active to avoid interruptions in treatment.

Job description:

• Place outbound calls approximately 35+ daily, with 20 cases or more closed per day.
• Contact insurance providers to verify information and verify coverage changes.
• Insurance Benefit Management: Collect and review patient insurance benefit information according to program SOPs; complete and submit insurance forms and prior authorizations in a timely manner, ensuring accuracy and adherence to third-party payer requirements.
• Customer Service & Support: Assist physician office staff and patients with insurance forms and program applications; provide exceptional customer service to internal and external customers, resolving requests promptly and escalating complaints as needed.
• Communication & Coordination: Maintain regular phone contact with provider representatives, third-party customer service reps, and pharmacy staff; effectively communicate with payors for benefit investigations and coordinate with inter-departmental associates as necessary.
• Documentation & Reporting: Process insurance and patient correspondence; report reimbursement trends or delays to the supervisor; provide all necessary documentation for prior authorizations, including demographic details and relevant identification numbers.
• Problem-Solving & Compliance: Analyze moderate scope problems within defined SOPs, exercising judgment to determine appropriate actions; report all adverse events in line with training and SOP; perform related duties as assigned with minimal instruction.

Requirements:

• Must have (1) year of experience in specialty pharmacy, medical insurance, healthcare setting, and/or related experience.
• Must be patient: Hold times may be up to 90 minutes by client requirements.
• Must have a private, designated workspace.
• Must be MS Office proficient: Excel, Outlook, Word.
• Must be flexible on schedule and hours.
• Must have a personal cellphone for MFA.
• Employment verification required: Last (3) employers.
• High school diploma or equivalent.
• Background check required.

#IND789

Job Types: Full-time, Contract

Pay: $17.00 - $19.00 per hour

Application Question(s):

• Are you located within 35 miles of Lake Mary, FL (required for equipment pickup/training)

Experience:

• Prior Authorizations: 2 years (Required)
• Co-Pay, deductibles: 2 years (Required)
• Health Insurance: 2 years (Required)
• Medical terminology: 2 years (Required)

Location:

• Deltona, FL (Required)

Work Location: Remote