BILLING AND INSURANCE VERIFICATION SPECIALIST

Position Summary:
The Billing/Insurance Verification Specialist is responsible for ensuring accurate and timely verification of insurance coverage, billing, and payment processing. This role requires a detail-oriented individual who can navigate healthcare insurance systems, interact with patients and providers, and resolve discrepancies to ensure efficient revenue cycle management.

Key Responsibilities:

Insurance Verification:

• Verify patient insurance coverage and eligibility prior to appointments or procedures.
• Confirm policy details, including copays, deductibles, and coverage limitations.
• Obtain necessary pre-authorizations or referrals from insurance companies.
• Communicate with insurance carriers to clarify benefits and resolve discrepancies.

Billing:

• Prepare and submit accurate claims to insurance companies for reimbursement.
• Review claims for errors, ensuring compliance with regulatory standards and insurance policies.
• Follow up on unpaid claims, identify denials, and resolve issues promptly.
• Maintain accurate billing records, including patient account updates.
• Payment Posting
• Familiarity of aging reports. Be able to analyze, update, and communicate aging report information. Insurance AR report, Office Patient Care AR report.
• Important how they report back to the team following formats(customized to the office needs)

Patient Communication:

• Notify patients of insurance coverage, copays, and potential out-of-pocket expenses.
• Assist patients with billing inquiries, payment plans, and financial counseling.
• Explain insurance-related terms and processes in a clear, patient-friendly manner.
• Provide personalized guidance to help patients evaluate their healthcare needs and select the most appropriate plan.

Administrative Duties:

• Maintain up-to-date knowledge of insurance policies, industry standards, and regulations.
• Coordinate with healthcare providers and office staff to streamline billing and verification processes.
• Accurately document all communication with patients and insurance companies in the system.
• Generate and review reports related to billing, insurance claims, and payment status.

Qualifications:

• Prior experience in medical billing, insurance verification, or healthcare administration.
• Familiarity with medical terminology, CPT/ICD codes, and insurance billing software.
• Proficiency in Microsoft Office Suite and electronic health record (EHR) systems.

Skills and Competencies:

• Strong organizational and multitasking abilities.
• Excellent communication and customer service skills.
• Analytical and problem-solving capabilities for resolving billing or insurance issues.
• High level of accuracy and attention to detail.
• Ability to handle sensitive patient information confidentially and comply with HIPAA regulation

Working Conditions:

• Working hours will adhere to US Time Zone, and must also be amenable to shifting schedule, holidays, graveyard, etc. depending on the business needs
• Fully remote

About the Company

Outsource Accelerator is the trusted source for independent information, advisory and expert implementation of Business Process Outsourcing (BPO). We are the #1 Outsourcing Authority, and we offer the worlds leading aggregator marketplace for outsourcing.

We specifically provide the conduit between Philippines outsourcing suppliers and the businesses clients across the globe. We continue to provide world-class talent to help small and medium-sized enterprises successfully build their offshore team in the Philippines.