Job Description

Medical Eligibility Specialist ~ 100 Openings!

Remote-US (MUST Reside Within 60 Miles of Dallas/Fort Worth)

REQUIRED 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

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

COMPENSATION & SCHEDULE

• $18/hr
• Schedule: Must be flexible Monday–Friday between 7AM to 7PM CST
• W2, Seasonal Project
• Start Date: 12/2/2025
• End Date: Estimated thru 3/2026
• Job ID: 152653

ROLE IMPACT

• Link between patients, providers, and insurance companies, helping patients access critical medications and devices
• Securing prior authorizations and validating benefits, your work supports timely treatment for conditions that are often life-threatening, rare, or costly
• 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

CORE TOOLS & SYSTEMS

• Microsoft Excel, Outlook, Word

• Insurance portals and EMR systems

• Document and case management platforms

• Phone systems and CRM/call tracking

LEGAL NOTICE

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