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Reimbursement/Verification Specialist (Work From Home)

About the Employer
  • Medix
hourly Salary
$16.00 - $17.00

Job Description

Job Description

 Pay Rate: $16 - $17/hr



Under the general supervision of the Supervisor and Manager, the Reimbursement

Specialist is responsible for various reimbursement functions, including but not limited to

benefit investigations, prior authorization support, and call triage. The Reimbursement

Specialist responds to all provider account inquiries, appropriately documents all

provider, payer and client interactions into the CareMetx Connect system and ensures

that the necessary data for prior authorization requests are obtained.



  • Collects and reviews all patient insurance benefit information, to the degree

  • authorized by the SOP of the program.

  • Provides assistance to physician office staff and patients to complete and submit

  • all necessary insurance forms and program applications.

  • Completes and submits all necessary insurance forms in a timely manner as

  • required by all third party payors for prior authorizations. Tracks and follow up on

  • prior authorization request.

  • Provides exceptional customer service to internal and external customers;

  • resolves any customer requests in a timely and accurate manner; escalates

  • complaints accordingly.

  • Maintains frequent phone contact with provider representatives, third party

  • customer service representatives, and pharmacy staff.

  • Reports any reimbursement trends/delays to the supervisor.

  • Processes any necessary insurance/patient correspondence.

  • Provides all necessary documentation required to expedite prior authorization

  • request. This includes demographic, authorization/referrals, National Provider

  • Identification (NPI) number, and referring physicians.

  • Coordinates with inter-departmental associates as necessary.

  • Communicates effectively to payors to ensure accurate and timely benefit

  • investigations.

  • Works on problems of moderate scope where analysis of data requires a review

  • of a variety of factors. Exercises judgment within defined standard operating

  • procedures to determine appropriate action.

  • Typically receives little instruction on day-to-day work, general instructions on

  • new assignments.

  • Performs related duties as assigned 





Previous 2+ years of experience in a physician’s office, healthcare setting, and/or

related experience.

Previous supervisory experience is preferred.



  • Ability to communicate effectively both orally and in writing.

  • Ability to build productive internal/external working relationships.

  • Strong interpersonal skills.

  • Strong negotiating skills.

  • Strong organizational skills; attention to detail.

  • General knowledge of pharmacy benefits, and medical benefits.

  • Global understanding of commercial and government payers preferred.

  • Ability to proficiently use Microsoft Excel, Outlook and Word.

  • Ability and initiative to work independently or as a team member.

  • Ability to problem solve.

  • Strong time management skills.

  • Customer satisfaction focused.



Company Description
About Medix?
Medix is dedicated to positively impacting lives every day. Since 2001, we have made it our mission to be the leading provider of workforce solutions for clients and candidates across the Healthcare, Scientific, and Information Technology industries.

Our dedicated recruiters are here to help you find and secure just the right opportunity. We take the time to learn about you, your skills, your interests, and your career goals, and then match you with the jobs and companies that best suit your needs. Whether you are looking for contract, contract-to-hire, or direct hire positions, we can help you to find the meaningful and gratifying work that you've been looking for. Let Medix be your partner as you move your career forward. Contact us today!

Once you have been a contract employee of Medix for 30 days, you become eligible for our Benefits Program. Should you elect to enroll, there are three levels of medical coverage to choose from, supplemental dental plans and term plans as well as the option to enroll your spouse and/or children. You can select the best combination that best suits your needs.
As a contract employee with Medix, you can choose to enroll in our Benefits Program during your eligibility period and enjoy:
●Minimum Essential Coverage (MEC) plan
●Two different fixed indemnity plan add-ons
●Major Medical Plans, including 1 HSA Plan
●Short-term disability
●Life and AD&D

This year’s recipient of the Business Ledger's "Entrepreneurial Excellence Growth Award"
Join our network of talented professionals!
Apply today!

Reimbursement/Verification Specialist (Work From Home)

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