Medical Benefits Specialist

2 days ago

Mandaue City, Central Visayas, Philippines beBeeMedicine Full time ₱400,000 - ₱600,000
Job Opportunity: Medical Benefits Verifier

We are seeking a skilled and detail-oriented individual to work as a Medical Benefits Verifier. In this role, you will be responsible for verifying patients' insurance coverage and benefits, ensuring accurate and timely verification of insurance information to facilitate smooth admissions, billing, and claims processes.

Job Responsibilities:
  1. Verify Patient Insurance Benefits
    1. Contact insurance companies by phone or via portals to verify patient coverage and eligibility.
    2. Gather detailed information on covered services, copays, deductibles, and prior authorization requirements.
    3. Accurately document all benefit details in the EHR or billing system.
  2. Submit Authorization Requests
    1. Prepare and submit prior authorization requests, including relevant clinical documentation.
    2. Follow up on pending authorizations with insurance carriers to ensure timely approvals.
    3. Maintain accurate records of all submitted authorizations.
  3. Track Authorization Expiry and Renewals
    1. Monitor and track expiration dates for existing authorizations.
    2. Proactively initiate renewal processes prior to expiration to avoid service disruptions.
    3. Notify the clinical and administrative teams of any issues or lapses.
  4. Coordinate with Clinical Staff
    1. Request and compile necessary clinical documentation for submissions.
    2. Communicate with clinicians to ensure all required documents are up to date and compliant.
    3. Ensure Compliance and Accuracy
    4. Maintain confidentiality and comply with HIPAA and internal data protection policies
    5. Ensure accurate data entry, documentation, and reporting of insurance verification and authorization status.
Required Skills and Qualifications:
  • At least 2 years of proven experience in medical billing, insurance verification, or healthcare administration required.
  • Strong knowledge of insurance terminology and benefit structures.
  • Excellent verbal and written communication skills.
  • Detail-oriented with the ability to multitask and manage time effectively.
  • Proficient in using spreadsheets, CRM tools, and insurance portals.
  • Reliable internet connection and a quiet, professional remote work environment.
Benefits:

This is a remote opportunity that offers flexibility and autonomy. You will have the chance to work with a dynamic team and contribute to the success of our organization.

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