Provider Validation Specialist

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

📋 Description

• Conduct research on healthcare providers to identify the correct custodians for various medical records and billing documents.

• Verify the appropriate method for submitting requests, whether by fax, email, online portal, or mail.

• Record the precise submission details, including contact information, attention lines, and specific requirements for each provider.

• Ascertain when requests should be categorized by record type, custodian, or service date.

• Ensure that authorization documents and request packets comply with provider-specific criteria.

• Review existing records prior to adding new entries and maintain provider information that is accurate, complete, and free of duplicates.

• Utilize databases, healthcare system websites, provider resources, NPI data, vendor portals, and other trusted sources to verify information.

• Perform phone verifications when necessary.

• Investigate any rejected or delayed requests, make necessary corrections, and escalate issues as needed.

• Document research outcomes, submission requirements, provider details, and updates for the benefit of other team members.

⛳️ Requirements

• Exceptional written English skills with a keen attention to detail.

• Strong abilities in research and information verification.

• Capability to analyze diverse sources and pinpoint accurate information.

• Excellent organizational and documentation skills.

• Proficiency in identifying discrepancies, missing details, and duplicate records.

• Ability to work independently while adhering to established processes.

• Strong problem-solving capabilities and follow-up skills.

• Willingness to work a schedule that coincides with U.S. Eastern Time business hours.

• Candidates selected for consideration may need to complete a timed skills assessment independently, without the aid of AI tools.

• Familiarity with basic HIPAA authorization requirements.

• Prior experience in medical records is not mandatory.

• Preferred experience in researching healthcare providers, facilities, or billing entities.

• Preferred familiarity with Release of Information (ROI), Health Information Management (HIM), medical billing, UB-04 or CMS-1500 claim forms, NPI lookups and verification, Explanation of Benefits (EOBs), legal support, medical records retrieval or release processes, and record-release or healthcare information vendors.

🏝️ Benefits

• Full-time remote work opportunity.

• Chance to gain experience in healthcare information and medical records processes.

• Opportunities for advancement into senior validation, provider data, quality, or team leadership positions.

• A collaborative and fast-paced work environment that emphasizes accuracy and continuous improvement.