Medical Insurance Processor jobs

The Insurance Verification and Authorization Specialist is responsible for ensuring the financial clearance of scheduled patient services.

Key responsibilities include verifying insurance benefits, obtaining required authorizations and HMO referrals, and completing timely admission notifications for bedded patients. The role collaborates with internal teams to resolve insurance-related concerns and patient inquiries.The ideal candidate should have strong customer service and communication skills, excellent critical-thinking and problem-solving abilities, and the ability to multitask and make timely decisions in a fast-paced healthcare environment.

Key Responsibilities:

• Obtain HMO referrals when required before the patient’s scheduled service.
• Contact insurance companies by phone or online portal to verify benefits and authorization requirements.
• Submit authorization requests, provide required clinical information, and follow up on approval decisions.
• Coordinate with providers, utilization management, patient financial services, and other departments to resolve insurance-related concerns.
• Contact patients when additional information is needed for accurate and timely billing.
• Complete admission notifications for hospitalized patients according to insurance and department requirements.
• Work with vendor partners to ensure timely screening for Medicaid coverage.
• Maintain accurate and complete documentation in the EMR for financial clearance and account activity.
• Manage EPIC work queues, including insurance verification and accurate account documentation.
• Follow established procedures and communication standards to support a consistent and positive patient experience.
• Address patient questions and concerns, escalating complex issues to the appropriate team when needed.
• Handle inbound calls and aim to resolve concerns during the first interaction
• Coordinate with other departments to ensure a smooth and positive patient experience.

Qualifications:

• At least 2 years of experience in the US healthcare industry, preferably in Revenue Cycle Management (RCM), with working knowledge of insurance and benefits.
• Prior experience using EPIC is required.
• Knowledge of medical terminology, diagnostic coding, and CPT coding guidelines.
• Proficient in Microsoft Office applications.

Technical Requirements:

• Own desktop or laptop (Core i5 or higher to serve as a backup device)
• Primary internet connection with a minimum speed of 50Mbps.
• Secondary internet connection to serve as a backup.

Other Details:

• Permanent WFH
• Independent Contract Graveyard shift (Central Time)
• Equipment provided (Desktop computer)

Pay: Php40,000.00 - Php45,000.00 per month

Benefits:

• Work from home

Application Question(s):

• Do you have experience with insurance verification and predetermination?

Experience:

• US Healthcare: 2 years (Required)
• EPIC: 1 year (Required)

Work Location: Remote