Continued Qualifications Specialist

We are seeking a detail-oriented and customer-focused Continued Qualification Specialist to join our growing healthcare operations team. In this role, you will help ensure patients receiving home-based therapy continue to meet insurance and coverage requirements, enabling uninterrupted access to care.

The ideal candidate has experience working with insurance verification, authorizations, healthcare documentation, and patient communication. This position offers the opportunity to make a direct impact on patient outcomes while collaborating with providers, payers, and internal teams.

Description

• Serve as a key point of contact for patients, healthcare providers, insurance carriers, and internal stakeholders.
• Contact patients to verify ongoing therapy usage, insurance coverage, and provider information.
• Obtain required medical documentation from healthcare providers to support continued insurance coverage and authorization.
• Review patient eligibility based on payer guidelines, clinical requirements, and coverage limitations.
• Manage insurance reauthorization activities and ensure timely submission of required documentation.
• Maintain accurate records of patient information, insurance details, authorizations, and communication activities.
• Work closely with billing and reimbursement teams to support accurate and timely claims processing.
• Investigate and resolve insurance-related issues, including authorization delays and denials.
• Escalate concerns that could impact patient care, reimbursement, or claim submission timelines.
• Ensure compliance with HIPAA, payer requirements, and applicable healthcare regulations.
• Identify opportunities to improve workflows and contribute to operational excellence initiatives.

Additional Skills & Qualifications

• High school diploma or equivalent.
• Experience in insurance verification, prior authorization, medical billing, reimbursement, or a related healthcare function.
• Knowledge of commercial insurance, Medicare, Medicaid, and managed care plans.
• Familiarity with medical terminology, CPT codes, and ICD-10 coding.
• Experience working with electronic health records (EHRs), insurance systems, and healthcare databases.
• Strong organizational skills and attention to detail.
• Excellent written and verbal communication skills.
• Strong customer service and relationship-building abilities.
• Ability to manage multiple priorities in a fast-paced environment.
• Knowledge of HIPAA and patient confidentiality requirements.
• Preferred Qualifications
• Additional education or training in healthcare administration, medical billing, health information management, or a related field.
• Experience supporting home health, durable medical equipment (DME), rehabilitation, or other healthcare services requiring insurance authorization.

Job Type & Location

This is a Contract to Hire position based out of Plymouth Valley, PA.

The pay range for this position is $22.00 - $24.00/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 fully onsite position in Plymouth Valley,PA.

This position is anticipated to close on Sep 15, 2026.

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

We’re 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. We’re 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. We’re strategic thinkers, hands-on collaborators, helping customers capitalize on change and master the momentum of technology. We’re 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.