Insurance Verification Specialist – AdvancedMD | Permanent WFH

We are seeking an experienced Insurance Verification Specialist to join our healthcare revenue cycle team. This role is responsible for accurately verifying patient insurance eligibility, benefits, and coverage requirements prior to appointments and procedures.

The ideal candidate has hands-on experience using AdvancedMD, strong knowledge of medical insurance and payer requirements, and experience working in a high-volume healthcare environment. Candidates with experience in orthopedics, pain management, podiatry, or gastroenterology (GI) are highly preferred.

Key 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 escalate 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.
  
  

Qualifications

• 2+ years of experience in medical insurance verification, eligibility, or a related healthcare RCM role.
• Hands-on experience with AdvancedMD is required.
• Strong understanding of commercial insurance, Medicare, Medicaid, and other health plans.
• Proven 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.
• Strong research, problem-solving, and organizational skills.
• Experience working with one or more of the following specialties is highly preferred:
• Orthopedics
• Pain Management
• Podiatry
• Gastroenterology (GI)
  

Perks

• Permanent Work From Home
• Leave Credits
• Monetary Allowance
• Annual Bonus
• Weekly Paychecks
• Fixed Weekends Off
• Thriving Company Culture with Complete Autonomy
• Exclusive Specialized Training Programs
• Unlock Your Potential with a Highly Competitive Salary
  
  

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Who are we?

BizForce is one of the fastest-growing global outsourcing companies in the world, founded in the US in Tucson, Arizona and is now operational in PH!

Our Commitment to delivering high-quality results for our clients and the only way to do that is ensuring a rewarding, respectful and productive experience for our employees. We hold the same values for both our customers and our employees.