Full-Time Insurance Verification Specialist | US Eastern Time

OVA Virtual; United States; Remote; USD 8,300 - 11,000; Full time

Job summary

OVA Virtual is seeking an Insurance Verification Specialist to support a US-based digital health company. The role requires HIPAA-conscious handling of PHI, knowledge of US health insurance, and the ability to verify coverage and explain EOBs.

You will work full-time during US Eastern hours, with a Philippine night-shift overlap, in a remote setup. The ideal candidate has 1–3 years in US healthcare access or insurance verification, a Bachelor's degree or equivalent, and strong data-entry skills

Qualifications

• Bachelor's degree or equivalent.
• 1-3 years of US healthcare patient access, insurance verification, or healthcare customer support.
• Working knowledge of US health insurance including Medicare, Medicare Advantage, Medigap, Medicaid, and commercial plans.
• Understanding of primary and secondary insurance coverage.
• Ability to read and interpret Explanation of Benefits (EOBs) and explain deductibles, co-insurance, co-pays, and patient responsibility.

Responsibilities

• Insurance Verification: verify and update primary/secondary insurance information; validate patient identity per HIPAA; use eligibility tools, Availity, payer portals, or payer calls; update billing system; prioritize coverage issues.
• Handle inbound patient calls/messages regarding medical bills and EOBs; explain EOB details in plain language; document inquiries and route to billing team; follow up until resolution.
• Records and Documentation: maintain logs of calls and outcomes; document verifications and billings accurately; flag unreachable patients for action; ensure PHI handling compliance.
• Coordination with Internal Teams: work with Claims Submission and AR teams on denials; communicate issues to appropriate teams; follow through on insurance-related items.

Skills

US English

Active listening

Clear patient communication

Data entry

PHI handling

HIPAA

EOB interpretation

Education

Bachelor's degree or equivalent

Tools

Microsoft Excel

Job description

Full-Time Insurance Verification Specialist | US Eastern Time

Full-time | 9:00 AM-6:00 PM US Eastern Time. Philippine schedule: approximately 9:00 PM-6:00 AM during US daylight saving time and 10:00 PM-7:00 AM during US standard time.
Rate: $6 per hour

Overview

We are looking for a detail-oriented, patient-focused Insurance Verification Specialist to support a US-based digital health company.

We are looking for the following specific requirements

• Bachelor's degree or equivalent.
• 1-3 years of experience in US healthcare patient access, insurance verification, or healthcare customer support.
• Working knowledge of US health insurance, including Medicare, Medicare Advantage, Medigap, Medicaid, and commercial insurance plans.
• Understanding of primary and secondary insurance coverage.
• Ability to read and interpret Explanation of Benefits (EOBs) and explain deductibles, co-insurance, co-pays, and patient responsibility.
• Knowledge of insurance eligibility and coverage verification using eligibility tools, Availity, payer portals, and payer phone lines.
• Understanding of HIPAA requirements and proper handling of Protected Health Information (PHI).
• Excellent spoken US English, active listening, and clear patient communication.
• Accurate data entry skills and basic proficiency in Microsoft Excel.
• Willingness and ability to work full-time during US Eastern business hours, including the corresponding Philippine night shift.

Your responsibilities will include (but are not limited to):

• Insurance Verification
  • Call patients enrolled in RPM, CCM, PCM, and RTM programs to confirm existing insurance information or collect updated details.
  • Verify and update primary and secondary insurance information, including payer names, member IDs, group numbers, subscriber details, and plan changes.
  • Verify patient identity before discussing any patient information, following HIPAA requirements.
  • Check patient insurance eligibility and coverage using eligibility verification tools, Availity, Medicare portals, other payer portals, or direct calls to insurance payers.
  • Accurately and promptly update verified insurance details in the billing system.
  • Prioritize patients with insurance coverage issues, including inactive policies, new Medicare Advantage plans, and missing secondary insurance.
  • Prioritize patients flagged by the billing team for insurance verification or follow-up.
  • Conduct additional patient outreach during Medicare Annual Enrollment (October-December) and in January, when many patients change insurance plans.
• Handle inbound patient calls and messages regarding medical bills, billing statements, and Explanation of Benefits (EOBs).
• Explain EOB information in plain language, including the amount billed, the amount paid by insurance, and any remaining patient responsibility.
• Gather and document complete details for each patient billing inquiry.
• Route billing questions and unresolved issues to the appropriate billing team member.
• Contact patients with updates or answers provided by the billing team.
• Follow up on open billing inquiries until the patient’s question is resolved and the case is closed.
• Acknowledge patient billing inquiries on the same day and provide a callback within two business days.
• Records and Documentation
  • Maintain an accurate log of every patient call, its outcome, and the next required action.
  • Document insurance verification results, coverage changes, billing inquiries, and follow-up activities accurately and promptly.
  • Flag patients who cannot be reached, have no insurance, or wish to discontinue their care program so the appropriate care and billing teams can take action.
  • Handle all patient information and documentation in accordance with HIPAA requirements and applicable PHI-handling procedures.
  • Coordination with Internal Teams
  • Coordinate with the Claims Submission and Accounts Receivable (AR) teams to address insurance-related claim rejections and denials.
  • Communicate insurance discrepancies, coverage issues, and unresolved patient billing concerns to the appropriate internal teams.
  • Follow through on assigned insurance-related issues and patient inquiries until the necessary next steps have been completed.
• Performance and Quality Targets
  • Meet the daily outbound insurance verification call targets established by the Billing Manager.
  • Maintain at least 98% accuracy in insurance details entered into the billing system.
  • Ensure patient billing inquiries are acknowledged on the same day and callbacks are completed within two business days.
  • Contribute to a steady reduction in insurance-related claim rejections for the clinics supported.

We primarily hire talented Virtual Assistants to support clients from around the world in areas such as administration, customer service, social media management, e-commerce support, and more. We also occasionally open positions for specialized roles depending on client needs.