Hybrid Coverage Determination Representative (161260)

Job DescriptionJob Description

A-Line Staffing is now hiring Hybrid Coverage Determination Representative in San Antonio, TX!

The Hybrid Coverage Determination Representative will work for a leading healthcare company and has potential for full-time employment based on performance. This is a hybrid role requiring in-office work 3 days per week, with a rotating weekend schedule.

If you are interested in this position, please contact Austin Faris at 586-710-7941 or afaris@alinestaffing.com.

Hybrid Coverage Determination Representative Compensation

• Pay Rate: $17.50/hour
• Benefits are available to full-time employees after 90 days of employment
• A 401(k) with company match is available after 1 year of service

Position Highlights

• Hybrid position: 3 days per week in the San Antonio office (days TBD) and some weekend rotations
• Training Hours: 9:00 AM – 5:30 PM EST for the first 8 weeks (mandatory attendance; no planned time off during training)
• Post-training shifts: 8-hour shifts 8:00 AM – 8:00 PM EST, Monday–Friday, with rotating weekends
• Opportunity for full-time employment contingent on performance

Responsibilities

• Utilize multiple software systems to create Medicare Prior Authorization case reviews
• Review fax documents and forward to appropriate queues
• Maintain accurate, timely, and complete documentation of Coverage Determination/Appeal requests
• Meet or exceed government-mandated timelines while complying with productivity and quality standards
• Acquire and maintain knowledge of relevant and changing Medicare D guidance
• Participate in team meetings and development discussions with supervisors

Requirements

• High School Diploma or GED required
• Must have a dedicated, quiet workspace for remote days with wired internet meeting a minimum of 25 Mbps download / 5 Mbps upload
• Must be able to sit and focus for the duration of the shift
• Previous experience in data entry and navigating multiple applications using dual screens
• Pharmacy or medical background but not required
• Ability to work independently in a productivity-driven environment
• Positive and engaged attitude to support team goals

Qualifications

• Previous WFH experience is
• Experience in medical insurance or prior authorization roles is a plus

Worksite: San Antonio, TX
Number of Openings: 12
Start Date: 11/10/2025

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