Provider Validation Specialist

OpsArmy; Pasay; Teletrabalho; PHP 360 000 - 480 000; Tempo integral

Vantagens oferecidas por esta oferta de emprego

Full-time remote work

Advancement opportunities

Collaborative, fast-paced environment

Resumo da oferta

OpsArmy is hiring a Provider Validation Specialist for a remote role requiring overlap with US Eastern Time. You will research healthcare providers, identify custodians, verify submission requirements, and maintain precise provider data. The work emphasizes accuracy, thoroughness, and independent problem solving.

Ideal candidates will be highly organized, comfortable with HIPAA-relevant details, and capable of researching across multiple sources to prevent delays in records requests.

Qualificações

• Excellent written English with strong attention to detail.
• Strong research and information-verification skills.
• Ability to analyze multiple sources and identify accurate information.
• Strong organizational and documentation skills.
• Ability to identify discrepancies, missing information, and duplicate records.
• Comfortable working independently and following established processes.
• Strong problem-solving and follow-up skills.
• Ability to overlap with U.S. Eastern Time business hours.

Responsabilidades

• Identify Record Custodians: research providers and custodians for each record type.
• Verify Submission Requirements: confirm submission methods and provider-specific needs.
• Determine Request Requirements: identify separation by type, custodian, or date.
• Prepare Request Information: ensure forms and language meet provider requirements.
• Maintain Provider Information: update and deduplicate data accurately.
• Research and Verify Information: use databases, vendor portals, and NPI data.
• Resolve Issues: investigate delays and escalate when needed.
• Maintain Accurate Documentation: document findings for team use.

Conhecimentos

Excellent written English

Research and information verification

Attention to detail

Organizational skills

Independent work style

Descrição da oferta de emprego

Provider Validation Specialist

Job Type: Full-time
Work Setup: Remote
Schedule: Full-time; must have availability to overlap with U.S. Eastern Time (EST) business hours

About the Role

We are looking for a detail-oriented Provider Validation Specialist to support a medical records retrieval workflow.

In this role, you will research healthcare providers and identify the appropriate custodians for different types of medical records and billing documents. You will verify submission requirements, prepare accurate request information, maintain provider data, and resolve issues that may delay records requests.

The ideal candidate is highly organized, comfortable conducting detailed research, and able to work accurately with healthcare, billing, and provider information.

Key Responsibilities

• Identify Record Custodians: Research healthcare providers and identify the appropriate custodian for each type of record, including records departments, billing offices, physician groups, radiology providers, ambulance services, and other third-party entities.
• Verify Submission Requirements: Confirm whether requests must be submitted by fax, email, online portal, or mail, and document exact submission details, contact information, attention lines, and provider-specific requirements.
• Determine Request Requirements: Identify when requests need to be separated by record type, custodian, or date of service.
• Prepare Request Information: Ensure authorization documents and request packets meet provider-specific requirements, including required language or provider-specific forms when applicable.
• Maintain Provider Information: Research existing records before adding new entries and maintain accurate, complete, and duplicate-free provider information.
• Research and Verify Information: Use available databases, healthcare system websites, provider resources, NPI information, vendor portals, and other reliable sources to verify details. Phone verification may also be required.
• Resolve Issues: Investigate rejected or delayed requests, identify the cause, make appropriate corrections, and upscale issues when necessary.
• Maintain Accurate Documentation: Clearly document research findings, submission requirements, provider information, and updates so other team members can act on the information.

Required Qualifications

• Excellent written English with strong attention to detail.
• Strong research and information-verification skills.
• Ability to analyze multiple sources and identify accurate information.
• Strong organizational and documentation skills.
• Ability to identify discrepancies, missing information, and duplicate records.
• Comfortable working independently and following established processes.
• Strong problem-solving and follow-up skills.
• Ability to work a schedule that overlaps with U.S. Eastern Time business hours.

Skills Assessment

Shortlisted candidates may be asked to complete a timed skills assessment independently and without the use of AI tools.

The assessment may evaluate:

• Identifying healthcare providers, custodians, and billing entities
• Determining when requests should be separated
• Verifying submission methods and provider-specific requirements
• Understanding basic HIPAA authorization requirements
• Research persistence and information verification
• Identifying errors, gaps, and duplicate information
• Knowing when to resolve an issue independently and when to upscale

Prior medical records experience is not required. The assessment focuses on research, reasoning, accuracy, and problem-solving skills.

Preferred Experience

Experience in any of the following areas is an advantage:

• Researching healthcare providers, facilities, or billing entities
• Release of Information (ROI)
• Health Information Management (HIM)
• Medical billing
• Experience with UB-04 or CMS-1500 claim forms
• NPI lookups and verification
• Explanation of Benefits (EOBs)
• Legal support, particularly personal injury or medical malpractice
• Medical records retrieval or release processes
• Experience working with record-release or healthcare information vendors

Key Skills

• Healthcare provider research
• Data verification and accuracy
• Document and information review
• Medical billing knowledge
• Research and investigation
• Database management
• Attention to detail
• Written communication
• Problem-solving
• Organization and follow-through

What We Offer

• Full-time remote work
• Opportunity to develop experience in healthcare information and medical records processes
• Opportunities for advancement into senior validation, provider data, quality, or team leadership roles
• A collaborative, fast-paced work environment focused on accuracy and continuous improvement