Insurance Verification & Authorization Specialist

This is a Fully Remote Job
About Our Client:
This organization operates in the pediatric mental health care sector, providing virtual and in-person services across multiple states including Pennsylvania, Virginia, New Jersey, and Maryland, with plans for expansion into new markets in 2027. It focuses on a whole-child approach by addressing the interaction between brain, body, and behavior to treat root causes of challenges rather than symptoms. The organization is clinician-founded and emphasizes a collaborative and supportive environment aimed at improving mental health care for children and families.
About the Opportunity:
The INSURANCE VERIFICATION & AUTHORIZATION SPECIALIST supports the organization’s mission by ensuring children and families can access mental health care through accurate insurance verification, coordination of prior authorizations, and managing referrals. This role involves navigating complex behavioral health insurance requirements to resolve coverage issues and facilitate smooth patient experiences. The position is critical to reducing barriers to care and maintaining efficient workflow in a high-volume environment.
Responsibilities:
Verify insurance eligibility, coverage, and behavioral health benefits for new and existing patients.
Review patient inquiries for age, location, insurance participation, and service eligibility.
Identify complexities in insurance plans, including third-party administrators and coverage requirements.
Obtain, submit, and track prior authorizations and referrals to ensure timely care access.
Communicate with insurance carriers to resolve coverage discrepancies and clarify patient financial responsibilities.
Manage high-volume requests using internal ticketing and EHR systems while maintaining accurate documentation.
Collaborate with internal teams to resolve barriers to care.
Requirements:
Experience in healthcare insurance verification, eligibility, benefits determination, prior authorizations, or referrals.
Strong understanding of insurance terms such as copays, coinsurance, deductibles, and out-of-pocket costs.
Exceptional attention to detail and ability to manage high-volume workflows accurately.
Strong communication, organizational, and problem-solving skills.
Experience with behavioral health insurance benefits and specialty healthcare is a plus.
Familiarity with EHR systems like Athenahealth and insurance portals preferred.
Ability to maintain patient confidentiality and comply with HIPAA requirements.
Pay Range and Compensation Package:
Compensation: $23 to $25 per hour
Equal Opportunity Statement: Our client is an equal opportunity employer. They celebrate diversity and are committed to creating an inclusive environment for all employees. All qualified applicants will receive consideration for employment without regard to race, color, religion, gender, gender identity or expression, sexual orientation, or national origin.
Note:
TalentHop is a recruitment partner of this role. Please note that all employment decisions, including candidate assessment, interviews, hiring, compensation, and employment terms, are made exclusively by the hiring employer.

Work arrangement
Yes