Medical Billing & Insurance Specialist

Winning Assistants LLC; Philippines; Remote; PHP 519,000 - 606,000; Full time

Job summary

Winning Assistants LLC is seeking an experienced Medical Billing & Insurance Specialist to join a busy optometry practice. You will handle full‑cycle medical billing, verify patient eligibility, manage claims, and support revenue cycle activities while collaborating with a small clinic team.

Training on clinic‑specific processes will be provided. This is a full‑time, remote‑friendly role with standard business hours in EDT.

Qualifications

• Solid hands-on medical billing experience.
• Experience managing full-cycle medical billing and revenue cycle management (RCM).
• Experience with claim preparation, submission, and follow-up.
• Hands-on experience resolving claim denials and rejections and handling appeals.
• Strong insurance eligibility and benefits verification experience.
• Proficiency with Availity is required.
• Experience navigating insurance/payer portals.
• Experience with Blue Cross/Blue Shield, UnitedHealthcare, Aetna, Medicare, and Medicaid.
• Working knowledge of ICD-10, CPT codes, claim scrubbing, and medical coding.

Responsibilities

• Handle full-cycle medical billing and revenue cycle management.
• Verify patient eligibility, benefits, and coverage with payer portals.
• Scrub and submit claims, monitor status, and follow up on denials.
• Investigate and resolve claim denials and appeals as needed.
• Collaborate with medical scribe and Virtual Assistants to support workflows.

Skills

Medical billing

RCM

Insurance verification

Claims management

HIPAA compliance

English communication

Education

Healthcare billing certification (not required)

Tools

Availity

i-Pegasus

Dialpad

TriZetto

Job description

Job title: Medical Billing & Insurance Specialist

Position Type: Full-Time

Work Hours: 9:00 AM - 6:00 PM EDT

Work Days: Tuesday-Saturday

Salary: $6-$7/hour, depending on experience

Company Overview

A well-established optometry and eye care practice serving approximately 400 patients per month. The practice provides comprehensive vision and medical eye care while working with a variety of vision and medical insurance plans.

The team values accurate, efficient billing and strong revenue cycle management to maintain smooth clinic operations. The successful candidate will work closely with the practice's existing team and receive training on clinic-specific billing processes, systems, and SOPs.

Role Overview

Our client is looking for an experienced Medical Billing & Insurance Specialist with strong hands‑on experience in full-cycle medical billing, insurance verification, claims management, and revenue cycle management.

This is not an entry‑level or training‑only billing position. Candidates must have actual professional experience handling medical claims, denials, insurance verification, and payer portals.

Top 3 Priorities

1. Full-Cycle Medical Billing & Revenue Cycle Management

• Manage claims throughout the complete billing cycle.
• Prepare, review, and submit accurate claims.
• Monitor claim status and follow up on outstanding or unpaid claims.
• Investigate and resolve rejected and denied claims.
• Handle appeals and communicate with insurance companies as needed.
• Identify billing issues that may delay or prevent reimbursement.
• Maintain accurate billing records and support a healthy revenue cycle.

2. Insurance Verification

• Verify patient eligibility, benefits, and coverage accurately and efficiently.
• Work primarily with vision insurance plans, Blue Cross/Blue Shield, UnitedHealthcare, Aetna, Medicare, and Medicaid.
• Navigate payer portals, particularly Availity, to obtain insurance information.
• Complete insurance verification efficiently, with a target turnaround time of approximately 10 minutes per verification.
• Accurately document coverage, benefits, and relevant insurance information.

3. Medical Coding & Claims Scrubbing

• Review and scrub claims before submission to identify errors or missing information.
• Confirm that the appropriate diagnosis codes support the corresponding CPT/procedure codes for reimbursement.
• Identify potential coding-related issues that could lead to claim denials or delayed payments.
• Support clean and accurate claim submissions.
• Follow the practice's coding and billing guidelines; clinic-specific training will be provided.

Additional Responsibilities

• Work closely with the practice's medical scribe and other Virtual Assistants to support billing and administrative workflows.
• Maintain accurate and HIPAA‑compliant patient and billing documentation.
• Communicate billing or insurance issues clearly with the appropriate team members.
• Follow established clinic SOPs and billing processes.
• Participate in training with the clinic team and outgoing medical biller to ensure a smooth transition.

Systems & Tools

• Availity - proficiency required
• i-Pegasus - optometry-focused, cloud-based system; training will be provided
• Dialpad

Must-Have Experience

• Solid hands‑on medical billing experience; training or certification alone does not qualify.
• Experience managing full-cycle medical billing and revenue cycle management (RCM).
• Strong experience with medical claim preparation, submission, and follow‑up.
• Hands‑on experience resolving claim denials and rejections and handling appeals.
• Strong insurance eligibility and benefits verification experience.
• Proficiency with Availity is required.
• Experience navigating insurance/payer portals.
• Experience working with commercial and/or government insurance plans such as Blue Cross/Blue Shield, UnitedHealthcare, Aetna, Medicare, and Medicaid.
• Working knowledge of ICD-10, CPT codes, claim scrubbing, and medical coding principles as they relate to billing and reimbursement.
• Ability to identify billing or coding issues that could result in denials or delayed reimbursement.
• Strong attention to detail, accuracy, organization, and follow-through.

Preferred Experience

• Experience using TriZetto is preferred but not required
• Experience with i-Pegasus is a plus but not required, as training will be provided.
• Optometry or ophthalmology billing experience is a plus but not required.
• Candidates with medical billing experience from other healthcare specialties are welcome to apply.
• Previous remote or Virtual Assistant experience is preferred but not required.

Education & Licensing

• A medical or healthcare degree is not required.
• An active medical license is not required.
• Relevant professional medical billing experience is more important than a specific medical degree or license.

Basic Requirements

• Excellent written and spoken English.
• Comfortable communicating with insurance companies and internal team members.
• Ability to work independently while collaborating closely with the clinic team.
• Ability to learn and follow clinic‑specific billing SOPs.
• Strong understanding of patient confidentiality and HIPAA requirements.
• Must be able to submit an NBI Clearance and/or Local Police Clearance before onboarding.
• Must be available for video meetings with the camera on when required.

Technical Requirements

• Internet: Stable high‑speed internet connection (minimum 25 Mbps).
• Video: Working webcam for virtual meetings.
• Workspace: Quiet and professional work environment.
• Dedicated HR & Contractor Support Team: Access to world‑class support for questions, guidance, contract matters, and client communication.
• Premium VPN Access (Optional): A secure VPN license can be provided upon request to enhance privacy and security for client‑related tasks.
• HIPAA & Cybersecurity Training + Certification (Provided): Access to our internal HIPAA compliance training, cybersecurity modules, and certification to help you confidently handle PHI for U.S. healthcare clients.
• Top 1% VA Performance Training: Access to our proprietary training on communication, client management, productivity systems, and best practices to help you become a top‑performing VA and increase long‑term client retention.
• Client-Approved U.S. Holidays: Contractors may take U.S. holidays off according to the client's needs and schedule.
• Client-Approved Paid or Unpaid Time Off: Time off may be granted by your client. Paid time off is optional and only if offered by the client.
• Access to Tools & Resources: Templates, workflow guides, productivity tools, and client‑specific SOP support to help you perform at your best.
• Optional Performance-Based Incentives: Some clients may offer bonuses, incentives, or increased hours based on your performance.

These are optional resources and client-approved allowances available to you as an independent contractor. Any resources, training, or allowances listed are optional contractor perks and not employee benefits.