Insurance Verification Specialist

TekSystems is currently hiring for Fully Remote Medical Insurance Specialist Role! This position MUST sit on the EST time zone.

MUST HAVE: 2-5 years of medical insurance verification, Must have experience with all healthcare's. Must have experience on understanding patient bills and being able to understand medical benefits. EPIC experience is a HUGE plus!

Description

Provides assistance to patients and providers by confirming and completing required pre-certification/authorizations prior to

service to ensure a positive patient/provider experience and mitigate denials.

Contributes to the achievement of established department goals and objectives and adheres to department policies,

procedures, quality standards, and safety standards. Complies with governmental and accreditation regulations.

2. Attends training sessions and workshops offered, to include but not limited to, CRCS Training, bulletin review, etc.

Attends and successfully completes required Continuing Education Units (CEU) for the PFS Training Program or other

departments as required.. Completes annual mandatory training (SITEL) within defined time frame.

3. Pre-Authorizations/Pre-Certification: Verifies eligibility and conformance to the department and departmental managed

care requirements and contracts. References the MedStar Managed Care Matrix and online Handbook as necessary.

Obtains insurance referrals and pre-authorizations. Submits all referral information to necessary providers, as

appropriate; Assists with pre-authorizations of scheduled procedures, including hospital admissions, procedures,

medications and medical equipment as required.

4. Reviews all scheduled procedures and initiates authorization and pre-certification activities. Reviews all provider

schedules confirms correct insurance information is available. Cross-references as needed to any application where

documentation is stored to ensure completeness of work.

5. Maintains ongoing communication with insurance companies to determine eligibility of benefits, deductible status, and to

obtain precertification for assigned scheduled procedures. Responds to provider/hospital staff and/or patient inquiries

regarding authorizations, and scheduling in an efficient manner.

6. Pre-Authorization/Pre-Certification: Ensures all relevant data is entered into the IDX application, links data to the

appropriate appointment/visit and enters the required data elements to ensure that accurate billing information is

submitted to the appropriate insurance carrier. Obtains any missing pre-certification or authorization numbers and enters

into the appropriate field in the Appointment Data Form (ADF) or other required fields as necessary. Communicates if

the appointment needs to be rescheduled due to a missing Referral or Authorization number.

7. Pre-Authorization/Pre-Certification: Confirms all relevant data is entered into SMS/Invision authorization fields to ensure

accurate billing information is submitted to the appropriate insurance carrier. Obtains any missing pre-certification or

authorization numbers and enters into the appropriate fields.

8. Monitors and completes the MedConnect Pre-Authorization Work Queue as required with accurate authorization status

and communicates with designated provider staff regarding any information required to complete the authorization

requirements. This includes but is not limited to additional documentation, Peer-to-Peer requests, etc.

9. Maintains current knowledge of regulatory and specific changes as it relates to Pre-Authorization and Pre-Certification

requirements.

10. Maintains daily performance benchmarks as it applies to interpreting and evaluating Pre-Authorization and Pre-

Certification requirement to include follow up with payers and assigned providers

11. Maintains departmental Quality Assurance standards within established error rate.

12. Participates in PFS or PUBS workgroups, staff meetings and work events.

13. Participates in multi-disciplinary quality and service improvement teams.

14. Maintains professional, positive, and effective communication with payers, providers, and staff.

15. Maintains confidentiality of all information pertaining to all of the patients reviewed.

Additional Skills & Qualifications

2-5 years of healthcare insurance verification experience. High volume healthcare IV experience, authorizations experience is a huge plus. Understanding of all of the insurances and plans. Experience with EPIC is a HUGE plus!

Working knowledge and demonstrated proficiency in payer authorization and clearance processes.

Requires basic working knowledge of UB04, HCFA 1500 or equivalent and payer responses.

Requires some knowledge of medical terminology and CPT/IDC-9 coding.

Excellent communication, analytical, interpersonal, and organizational skills.

Proficient uses of hospital registration and/or billing systems and personal computers as well as Microsoft Excel

and Word applications.

Ability to type 35 WPM.

Job Type & Location

This is a Contract to Hire position based out of Baltimore, MD.

The pay range for this position is $20.00 - $23.00/hr.

Individual compensation offered for this position within this range will depend on many factors, including qualifications, skills, relevant experience, job knowledge, geographic location, internal equity, and other pertinent job-related factors.

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 Contract to Hire position based out of Baltimore, MD.

This position is anticipated to close on Nov 23, 2026.

This is a fully remote position.

About TEKsystems

We're partners in transformation. We help clients activate ideas and solutions to take advantage of a new world of opportunity. We are a team of 80,000 strong, working with over 6,000 clients, including 80% of the Fortune 500, across North America, Europe and Asia. As an industry leader in Full-Stack Technology Services, Talent Services, and real-world application, we work with progressive leaders to drive change. That's the power of true partnership. TEKsystems is an Allegis Group company.

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

About TEKsystems and TEKsystems Global Services

Were a leading provider of business and technology services. We accelerate business transformation for our customers. Our expertise in strategy, design, execution and operations unlocks business value through a range of solutions. Were a team of 80,000 strong, working with over 6,000 customers, including 80% of the Fortune 500 across North America, Europe and Asia, who partner with us for our scale, full-stack capabilities and speed. Were strategic thinkers, hands-on collaborators, helping customers capitalize on change and master the momentum of technology. Were building tomorrow by delivering business outcomes and making positive impacts in our global communities. TEKsystems and TEKsystems Global Services are Allegis Group companies. Learn more at TEKsystems.com.

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.

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.