Medical Billing & Insurance Specialist
W
Winning AssistantsOptometry and eye care
Workable locations: Philippines, 9:00 AM – 6:00 PM EDT; Tuesday–SaturdayFull-Time
Salary6 - 7 USD per hour
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Job Details
- Languages
- Excellent written and spoken English.
- Required Skills
- HIPAA
Requirements
- Have solid hands-on professional medical billing experience; training or certification alone does not qualify.
- Have experience managing full-cycle medical billing and revenue cycle management.
- Have strong experience preparing, submitting, and following up on medical claims.
- Have hands-on experience resolving claim denials and rejections and handling appeals.
- Have strong insurance eligibility and benefits verification experience.
- Be proficient with Availity and experienced navigating insurance and payer portals.
- Have experience with commercial and/or government insurance plans, such as Blue Cross/Blue Shield, UnitedHealthcare, Aetna, Medicare, and Medicaid.
- Have working knowledge of ICD-10, CPT codes, claim scrubbing, and medical coding principles as they relate to billing and reimbursement.
- Be able to identify billing or coding issues that may cause denials or delayed reimbursement.
- Have excellent written and spoken English and be comfortable communicating with insurance companies and internal team members.
- Be able to work independently, collaborate with the clinic team, and learn and follow clinic-specific billing SOPs.
- Understand patient confidentiality and HIPAA requirements.
- Have a reliable computer, stable high-speed internet of at least 25 Mbps, a noise-canceling headset, a working webcam, and a quiet professional workspace.
- Be available for video meetings with the camera on when required.
- Submit an NBI Clearance and/or Local Police Clearance before onboarding.
- TriZetto, i-Pegasus, optometry or ophthalmology billing, and previous remote or Virtual Assistant experience are preferred but not required.
Responsibilities
- Manage claims throughout the full billing cycle, from preparation and submission to status monitoring and follow-up.
- Investigate and resolve rejected and denied claims, handle appeals, and communicate with insurance companies as needed.
- Verify patient eligibility, benefits, and coverage, and document relevant insurance information.
- Navigate Availity and other insurance and payer portals to obtain insurance information.
- Review and scrub claims before submission to identify errors or missing information.
- Confirm that diagnosis codes support corresponding CPT and procedure codes for reimbursement.
- Identify billing or coding issues that could lead to denials, delayed payments, or delayed reimbursement.
- Maintain accurate, HIPAA-compliant patient and billing documentation.
- Coordinate billing and administrative workflows with the medical scribe, Virtual Assistants, and practice team.
- Follow clinic SOPs and billing processes and participate in transition training.
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