Medical Billing & Insurance Specialist

This is a fully remote position, open to applicants in Philippines.

📋 Description

• Oversee claims throughout the entire billing cycle.

• Prepare, review, and accurately submit claims.

• Track claim status and follow up on claims that are outstanding or unpaid.

• Investigate and resolve claims that have been rejected or denied.

• Manage appeals and liaise with insurance companies as necessary.

• Identify billing issues that may hinder or delay reimbursement.

• Maintain precise billing records and contribute to a robust revenue cycle.

• Verify patient eligibility, benefits, and coverage.

• Collaborate with vision insurance plans, including Blue Cross/Blue Shield, UnitedHealthcare, Aetna, Medicare, and Medicaid.

• Navigate payer portals, especially Availity.

• Complete insurance verifications aiming for a turnaround time of approximately 10 minutes.

• Document coverage, benefits, and pertinent insurance information.

• Review and scrub claims prior to submission.

• Ensure diagnosis codes align with corresponding CPT/procedure codes.

• Detect coding-related issues that may lead to claim denials or payment delays.

• Promote clean and accurate submissions of claims.

• Adhere to the practice’s coding and billing standards.

• Collaborate closely with the medical scribe and other Virtual Assistants.

• Maintain accurate and HIPAA-compliant patient and billing documentation.

• Clearly communicate billing or insurance issues to appropriate team members.

• Follow established clinic SOPs and billing procedures.

• Engage in training sessions with the clinic team and outgoing medical biller to ensure a seamless transition.

⛳️ Requirements

• Extensive hands-on experience in medical billing; training or certification alone is not sufficient.

• Experience managing comprehensive medical billing and revenue cycle management (RCM).

• Strong background in medical claim preparation, submission, and follow-up.

• Practical experience in resolving claim denials and rejections, along with handling appeals.

• Strong expertise in insurance eligibility and benefits verification.

• Proficiency with Availity is mandatory.

• Familiarity with navigating insurance/payer portals.

• Experience working with commercial and/or government insurance plans such as Blue Cross/Blue Shield, UnitedHealthcare, Aetna, Medicare, and Medicaid.

• Working knowledge of ICD-10, CPT codes, claim scrubbing, and medical coding principles.

• Ability to identify billing or coding issues that may lead to denials or delayed reimbursements.

• Strong attention to detail, accuracy, organization, and follow-through.

• Excellent written and verbal English communication skills.

• Comfortable in communicating with insurance companies and internal team members.

• Ability to work independently while closely collaborating with the clinic team.

• Capability to learn and adhere to clinic-specific billing SOPs.

• Strong understanding of patient confidentiality and HIPAA regulations.

• Must provide an NBI Clearance and/or Local Police Clearance prior to onboarding.

• Must be available for video meetings with the camera on when required.

• Reliable laptop or desktop computer is essential.

• Stable high-speed internet connection, with a minimum of 25 Mbps.

• Noise-canceling headset is necessary.

• Working webcam required for virtual meetings.

• A quiet and professional work environment is essential.

• TriZetto experience is preferred but not mandatory.

• i-Pegasus experience is a plus but not required; training will be provided.

• Experience in optometry or ophthalmology billing is advantageous but not mandatory.

• Previous remote or Virtual Assistant experience is preferred but not essential.

• A medical or healthcare degree is not required.

• An active medical license is not necessary.

• Relevant professional medical billing experience is prioritized over specific medical degrees or licenses.

🏝️ Benefits

• Dedicated HR & Contractor Support Team.

• Optional Premium VPN Access.

• HIPAA & Cybersecurity Training + Certification (Provided).

• Top 1% VA Performance Training.

• Client-Approved U.S. Holidays.

• Client-Approved Paid or Unpaid Time Off.

• Access to Tools & Resources.

• Optional Performance-Based Incentives.

• Optional contractor perks and client-approved allowances.