Insurance Eligibility Checkers

Virtuale Staffing; Ormoc; On-site; PHP 201,000 - 312,000; Full time

Job summary

Virtual Staffing Solutions in the Philippines is seeking Eligibility Checkers to verify orthodontic insurance coverage and prepare accurate benefit details prior to consultations or treatment.

You will review eligibility, confirm plan specifics, and document information in the management system while coordinating with front office and insurers to resolve discrepancies and ensure smooth claims processing.

Qualifications

• BPO healthcare billing experience is required.
• Knowledge of insurance plans and eligibility concepts.
• Ability to read eligibility of benefits and denials.
• Strong communication and comprehension abilities.
• Proficient with basic computer applications and word processing.

Responsibilities

• Review and verify patient insurance eligibility for orthodontic procedures via portals or phone.
• Confirm coverage details including plan type, lifetime maximums, deductible, co-pay, coinsurance, and frequency limitations.
• Document all insurance information accurately in the patient management system.
• Communicate with insurance companies to clarify benefit details as needed.
• Flag and elevate issues such as ineligible coverage, policy terminations, or unusual plan exclusions.
• Coordinate with front office to inform patients of coverage prior to treatment.
• Maintain up-to-date knowledge of insurance providers’ policies and orthodontic codes (e.g., D8080, D8090).
• Meet performance standards for productivity, accuracy, and turnaround time.

Skills

BPO healthcare billing

Insurance plans

Eligibility checks

Communication skills

Computer literacy

Job description

Job Description

Virtual Staffing Solutions is looking for Eligibility Checkers. The Eligibility Checker is responsible for verifying patients’ insurance coverage and benefits specifically related to orthodontic treatment. This role ensures that accurate insurance information is available prior to consultations or treatment, enabling efficient claims processing and patient communication.

Key Responsibilities

• Review and verify patient insurance eligibility for orthodontic procedures via online portals or by phone.
• Confirm coverage details including plan type, orthodontic lifetime maximums, deductible, co-pay, coinsurance, and frequency limitations.
• Document all insurance information accurately in the patient management system.
• Communicate with insurance companies to clarify benefit details as needed.
• Flag and elevate issues such as ineligible coverage, policy terminations, or unusual plan exclusions.
• Coordinate with front office or scheduling teams to ensure patients are informed of their coverage prior to treatment.
• Maintain up-to-date knowledge of insurance providers’ policies and orthodontic codes (e.g., D8080, D8090).
• Meet performance standards for productivity, accuracy, and turnaround time.

Skills, Knowledge and Expertise

• At least 6 months BPO healthcare billing experience is a must
• Has knowledge in insurance plans
• Must be able to read eligibility of benefits, denials
• Excellent communication and comprehension skills
• Computer literate, in encoding, and word-processing