Remote Insurance Verification Specialist (AdvancedMD)

BizForce; Metro Manila; On-site; PHP 279,000 - 502,000; Full time

Benefits offered by this job

Permanent Work From Home

Leave Credits

Monetary Allowance

Annual Bonus

Weekly Paychecks

Fixed Weekends Off

Thriving Company Culture with Complete

Autonomy

Job summary

BizForce is seeking an experienced Insurance Verification Specialist to join our healthcare revenue cycle team. You will verify patient insurance eligibility, benefits, and coverage requirements prior to appointments and procedures, ensuring accuracy and compliance.

The role requires hands-on AdvancedMD experience and strong knowledge of commercial insurance, Medicare, and Medicaid. Ideal candidates will have 2+ years in medical insurance verification and thrive in a fast-paced environment,

Qualifications

• 2+ years of experience in medical insurance verification, eligibility, or a related healthcare RCM role.
• Hands-on experience with AdvancedMD.
• Strong understanding of commercial insurance, Medicare, Medicaid, and other health plans.
• Experience verifying eligibility, benefits, deductibles, copays, coinsurance, and coverage limitations.
• Knowledge of prior authorization, referral, and pre-certification requirements.
• Strong understanding of medical and insurance terminology.
• Excellent attention to detail and data-entry accuracy.
• Strong written and verbal communication skills.
• Ability to work independently while managing a high volume of verification requests.

Responsibilities

• Verify patient insurance eligibility and benefits before scheduled appointments, procedures, and services.
• Confirm coverage details, including effective dates, deductibles, copays, coinsurance, and out-of-pocket maximums.
• Determine in-network and out-of-network benefits and identify payer-specific requirements.
• Verify coverage for office visits, procedures, diagnostic testing, injections, imaging, surgeries, and other specialty services.
• Identify requirements for prior authorization, referrals, pre-certification, and medical necessity.
• Obtain and document authorization and referral information when required.
• Accurately enter, update, and maintain patient insurance information in AdvancedMD.
• Review patient demographics and insurance information for accuracy and completeness.
• Contact insurance carriers through payer portals and by phone to obtain and confirm benefit information.
• Clearly document verification results, payer communications, authorization details, and coverage limitations.
• Communicate insurance requirements and potential patient financial responsibility to scheduling, billing, authorization, and clinical teams.
• Collaborate with internal teams to resolve insurance discrepancies and coverage issues before services are rendered.
• Identify potential coverage problems that may lead to claim denials and elevate issues appropriately.
• Follow payer-specific guidelines, internal procedures, and quality standards while maintaining accuracy in a high-volume environment.
• Prioritize time-sensitive verification requests and ensure work is completed within established turnaround times.

Skills

Attention to detail

Data entry

Communication skills

Problem solving

Time management

Independent worker

Tools

AdvancedMD

Job description

BizForce is seeking an experienced Insurance Verification Specialist to join our healthcare revenue cycle team. You will verify patient insurance eligibility, benefits, and coverage requirements prior to appointments and procedures, ensuring accuracy and compliance.

The role requires hands-on AdvancedMD experience and strong knowledge of commercial insurance, Medicare, and Medicaid. Ideal candidates will have 2+ years in medical insurance verification and thrive in a fast-paced environment,