Insurance Verification (EOBs) and Scheduling

Location: Philippines We are seeking an articulate, proactive, and exceptionally thorough Insurance Verification Specialist and Scheduling Support to manage patient access and revenue cycle operations for our practice. In this front-line remote role, you will be responsible for end-to-end insurance eligibility and Verification of Benefits (VOBs), analyzing Explanations of Benefits (EOBs), resolving insurance discrepancies, and delivering top-tier patient care through telephone communications and appointment scheduling. Because this position involves constant live phone interaction with U.S. patients and insurance payors, clear, natural, and accent-neutral spoken English is an absolute, non-negotiable requirement . The ideal candidate possesses strong working knowledge of U.S. healthcare coverage structures—including clear expertise in distinguishing between In-Network vs. Out-of-Network benefits, Medicare/Medicaid guidelines, copays, deductibles, and coinsurance—while effortlessly handling front-office administration. Working Environment & Core Schedule Role Title: Insurance Verification (EOBs) and Scheduling Status: Full-Time (40 Hours / Week) Schedule: Monday – Friday, 8:00 AM – 5:00 PM PST (Pacific Standard Time) Core Systems: EMR / Practice Management Systems, Clearinghouse & Insurance Payor Portals, Practice VoIP Phone System, HIPAA-Compliant Messaging Tools Primary Scope: Insurance Eligibility & Benefits Verification (VOB), EOB Analysis & Payor Follow-Up, Patient Scheduling, and Front-Office Administrative Support Top 3 Daily Tasks Insurance Eligibility & Benefits Verification (VOB): Contact commercial and government insurance carriers to verify patient coverage, active benefits, in-network vs. out-of-network status, deductibles, copays, and pre-authorization requirements prior to appointments. EOB Review & Insurance Follow-Up: Review Explanations of Benefits (EOBs), identify claim adjudication issues, investigate unpaid or incorrectly processed claims, and perform routine follow-ups with payor representatives. Patient Scheduling & Appointment Coordination: Manage inbound and outbound patient phone calls to book, reschedule, and confirm appointments while updating patient demographics and insurance details in the EMR. Core Responsibilities Insurance Eligibility & VOB Management: Conduct comprehensive real-time benefits verifications for new and existing patients, entering structured coverage data into the EMR. Insurance Navigation (In-Network, Out-of-Network, Medicare): Differentiate insurance rules across commercial payors, Medi-Cal/Medicaid, and Medicare; accurately explain out-of-pocket costs to patients prior to service. EOB & Adjudication Support: Audit EOB statements to verify accurate payor payments, patient responsibility, and adjustment codes, following up on denied or stalled claims. Patient Communication & Phone Triage: Handle high-volume inbound and outbound phone calls with warmth, empathy, and accent-neutral English clarity, resolving patient inquiries without strict scripts. General Front-Office Administration: Coordinate appointment schedules, manage referral intakes, follow up on voicemails/emails, and maintain strict HIPAA data security standards across all systems. Requirements Accent-Neutral English Fluency: Exceptional verbal and written English communication; candidate must possess clear, natural, and accent-neutral spoken English for seamless phone calls with U.S. patients and insurance reps. Insurance Verification & EOB Mastery: Proven experience executing Verification of Benefits (VOB) and interpreting Explanations of Benefits (EOBs). Deep Understanding of U.S. Insurance Structures: Demonstrated fluency in distinguishing In-Network vs. Out-of-Network coverage, Medicare, copays, deductibles, maximum out-of-pocket limits, and prior authorizations. Patient Scheduling & Phone Support: 2+ years of experience handling inbound/outbound phone calls and appointment coordination in a U.S. medical office or virtual assistant environment. Schedule Availability: Full availability to work 40 hours per week during Monday through Friday, 8:00 AM – 5:00 PM PST . EMR & Systems Literacy: Hands-on experience navigating medical practice management software, clearinghouse portals, and VoIP phone systems. HIPAA WFH Workspace Setup: Dedicated, private home office with a lockable door, high-speed primary internet, backup internet/power solutions, a high-performance PC/Mac, and a noise-canceling headset. Ideal Candidate Profile You are a sharp, articulate healthcare specialist who speaks fluent, accent-neutral English and knows the ins and outs of U.S. health insurance. You easily navigate complex EOBs, verify patient coverage down to the cent, and provide warm, professional front-office support over the phone during standard PST business hours.