Medical Billing, Prior Authorization Specialist

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

📋 Description

• Oversee and process approximately 20–30 healthcare insurance claims from the US each day.

• Assess billing details, insurance coverage, provider information, and documentation prior to claim submission.

• Detect and rectify billing inconsistencies, rejected claims, and processing challenges.

• Ensure precise billing for psychologists, psychiatrists, and doctoral interns.

• Collaborate with insurance companies to address claim issues and sustain reimbursement processes.

• Manage prior authorization requests for behavioral health and psychiatric services.

• Confirm insurance requirements, coverage limitations, and authorization statuses.

• Work with providers, insurers, and internal staff to gather necessary documentation.

• Monitor pending authorizations and follow up on unresolved requests.

• Keep records of authorization approvals, denials, and expiration dates.

• Follow up on unpaid, pending, rejected, or denied claims.

• Maintain orderly billing records and track outstanding tasks efficiently.

• Assist in refining billing procedures and administrative workflows.

• Collaborate with the billing specialist and clinical team effectively.

• Communicate with clinics, insurance representatives, and patients professionally.

• Clarify insurance benefits, coverage, and billing responsibilities to patients.

• Provide clinic service information and address inquiries.

• Manage inbound and outbound calls using RingCentral.

• Support additional administrative duties as assigned.

⛳️ Requirements

• Previous hands-on experience in US healthcare insurance billing and claims processing is mandatory.

• Experience in handling insurance claims submissions, billing follow-ups, and resolving discrepancies is essential.

• Knowledge of prior authorization workflows, insurance eligibility, and benefits verification is required.

• Familiarity with US healthcare billing protocols, payer requirements, and insurance terminology is necessary.

• Strong attention to detail is crucial.

• Excellent organizational skills with the ability to manage multiple tasks and deadlines independently.

• Strong verbal communication skills with clear and comprehensible spoken English.

• Proficiency in speaking and writing English in a clear and professional manner.

• Comfort in communicating with US patients, insurance representatives, and healthcare professionals is essential.

• Submission of an NBI Clearance and/or Local Police Clearance is required prior to onboarding.

• Availability during US Central Time business hours and for occasional weekend follow-ups is necessary.

• Adherence to HIPAA guidelines and maintenance of patient information confidentiality is mandatory.

• A reliable computer with a minimum of 25 Mbps stable high-speed internet connection is required.

• A noise-canceling headset, functioning webcam, and a quiet professional workspace are essential.

• Experience in psychology, psychiatry, or behavioral health billing is highly preferred.

• Familiarity with TherapyNotes, Tebra, RingCentral, or similar healthcare systems is advantageous.

• Previous experience as a remote or healthcare virtual assistant is preferred, but not mandatory.

🏝️ Benefits

• Dedicated HR & Contractor Support Team.

• Premium VPN Access (Optional).

• 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.

• Flexible remote work arrangement.