Eligibility Specialist (Dermatology) - Remote | Philippines

Join Our Team at Skin and Cancer Institute!

Are you passionate about dermatology and skin health? Do you thrive in a dynamic, patient-focused environment? Skin and Cancer Institute is looking for dedicated professionals to join our team!

Why Join Us?

At Skin and Cancer Institute, we are committed to excellence in dermatology, skin cancer treatment, and cosmetic procedures. We offer a supportive and collaborative work culture where your skills and dedication make a real impact.

Summary of Position

• Reports to: Authorization Manager
• Work schedule: U.S. Pacific Time, Monday to Friday (maximum of 40 hours per week)
• Work Category: Full-time, Remote

The Insurance Eligibility Specialist verifies active insurance coverage, benefits, network status, patient cost-share information, and referral or authorization requirements before services are rendered. This position supports patient access and helps reduce preventable eligibility-related denials by documenting reliable coverage information and communicating discrepancies promptly.

The Insurance Eligibility Specialist owns verification of active coverage, plan benefits, network status, cost-share information, and coordination-of-benefits indicators. Identified referral and authorization requirements are routed to the teams responsible for those functions. Success requires organization, accuracy, and strong knowledge of payer requirements.

WHAT YOU'LL DO:

Insurance Eligibility Verification

• Verify active insurance coverage for all scheduled and referred patients prior to appointments, procedures, and treatments.
• Confirm member and subscriber information, effective and termination dates, coverage status, plan limitations, and network participation.
• Review commercial, Medicare, Medicaid, HMO, PPO, POS, Workers' Compensation, and managed care plans.
• Use payer portals, clearinghouses, electronic eligibility tools, and payer resources to obtain accurate eligibility information.
• Identify coverage issues and communicate findings to appropriate departments in a timely manner.

Benefits Verification

• Verify patient benefits, including deductibles, copays, coinsurance, out-of-pocket maximums, benefit accumulations, and service-specific coverage.
• Determine coverage requirements for office visits, procedures, surgeries, pathology, and diagnostic testing.
• Identify authorization, referral, precertification, and other payer requirements and route them to the appropriate team.
• Document benefit information accurately within designated systems and formats.
• Provide or support estimates based on available benefit information and communicate that verification does not guarantee coverage or payment.

Patient Financial Clearance

• Apply departmental financial-clearance criteria, including validation of demographics, subscriber data, active coverage, network status, benefits, and identified payer requirements.
• Identify duplicate, terminated, mismatched, or conflicting coverage and work with patients and internal teams to obtain updated information.
• Notify appropriate scheduling, clinical, and billing teams regarding insurance-related barriers to care.
• Coordinate with patients when eligibility issues may impact appointments or treatment plans.
• Support front-office and revenue cycle teams in resolving insurance verification concerns.

Documentation and Data Management

• Maintain accurate records of each verification, including the date, source, payer response, and outcome, within designated systems.
• Document benefit details, limitations, conflicting information, payer communications, representative names, and reference numbers according to departmental standards.
• Maintain electronic records in accordance with organizational policies and healthcare regulations.
• Review work queues and reports to prioritize verification activities based on appointment schedules and operational needs.
• Ensure timely updates to patient demographics, subscriber information, insurance data, and apparent coordination-of-benefits indicators.

Collaboration and Communication

• Communicate professionally with patients, providers, insurance representatives, and internal departments.
• Collaborate closely with scheduling teams, prior authorization staff, billing departments, and clinic personnel.
• Escalate complex eligibility issues to leadership when appropriate.
• Assist with cross-functional support activities as assigned.
• Participate in departmental meetings, process improvement initiatives, and organizational projects.

Compliance and Quality Assurance

• Adhere to HIPAA guidelines and patient confidentiality requirements.
• Maintain compliance with federal, state, payer, and organizational policies.
• Support quality assurance efforts through accurate documentation and verification practices.
• Stay current on insurance regulations, payer policy changes, and industry best practices.
• Meet departmental productivity, accuracy, and turnaround time standards.

Other Duties

• Assist with special projects and departmental initiatives.
• Support organizational growth, acquisitions, and integration efforts.
• Perform other duties as assigned.

WHAT WE'RE LOOKING FOR

Required Skills / Abilities:

• Strong knowledge of medical insurance eligibility and benefits verification processes.
• Understanding Medicare, Medicaid, commercial insurance, HMO, PPO, and managed care plans.
• Excellent customer service and interpersonal communication skills.
• Strong analytical and problem-solving abilities.
• Exceptional attention to detail and data-entry accuracy.
• Ability to prioritize and manage multiple tasks in a fast-paced environment.
• Strong organizational and time management skills.
• Ability to maintain confidentiality and professionalism at all times.
• Proficiency in Microsoft 365 applications, including Outlook, Excel, Word, and Teams.
• Working knowledge of EMR and practice management systems.
• Ability to interpret insurance plans, coverage rules, and payer policies.
• Ability to work independently and collaboratively within a team environment.

Education & Experience

Required

• High School Diploma or equivalent.
• Minimum of 2 years of experience in insurance verification, patient eligibility, medical billing, revenue cycle, healthcare administration, or related field.
• Experience using payer websites, portals, clearinghouses, and electronic eligibility tools.
• Basic knowledge of medical terminology and healthcare operations.

Preferred

• Associate's degree in healthcare administration, Business Administration, or related field.
• 3+ years of eligibility verification experience within a multi-specialty medical practice.
• Experience in dermatology, oncology, surgical, or specialty healthcare environments.
• Experience with Modernizing Medicine (EMA), ModMed, or similar EMR systems.
• Certified Revenue Cycle Representative (CRCR) or relevant healthcare certification.
• Experience in remote healthcare operations.

Equipment & Software Operation

The incumbent in this position may operate any/all of the following equipment:

• Microsoft Outlook, Word, Excel, PowerPoint, fax, email, phone, Microsoft Teams, Zoom Call Center, EMA, Klara and Next Patient

WHAT WE OFFER

Placement within the range will be based on objective, job-related factors, which may include relevant experience, education, training, skills, certifications, internal equity, and business considerations

• Competitive salary
• Night shift differential pay
• Statutory benefits
• Paid time off
• Professional development opportunities
• Supportive and fair work environment

Apply Today! Be a part of a dynamic team that’s transforming skin health. We can't wait to meet you!

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