Virtual Medical Biller / Insurance Verification Specialist
Location
PST (UTC-8)
Posted
3 days ago
Salary
0
Seniority
Mid Level
No structured requirement data.
Job Description
Virtual Medical Biller / Insurance Verification Specialist
Staffing for Doctors
Role Description We are seeking an experienced, full-time Virtual Medical Biller / Insurance Verification Specialist for a busy Pain Treatment Center to optimize billing efficiency and aggressively reduce a 15% claim denial rate. Operating within the Prognosis EMR (with an upcoming transition to AdvancedMD) and utilizing the Weave phone system, this remote role independently manages front-end benefits verification, secures complex prior authorizations for specialized procedures, conducts pre-submission claim audits, and manages appeals. Roles and Responsibilities - Insurance Verification & Prior Authorizations (Primary Focus) - Benefits Verification: Pre-verify patient insurance eligibility, deductibles, copays, and coinsurance prior to scheduled visits. - Prior Authorizations & Referrals: Compile clinical documentation to submit and track authorizations for pain injections, imaging, and procedures. - Proactive Review: Identify coverage exclusions or coordination of benefits (COB) issues before care is delivered to mitigate financial risk. - Medical Billing & Denial Management - Pre-Submission Audits: Review outpatient claims for completeness and correct coding modifiers to maximize clean claim rates. - Denial Investigation: Research, correct, and appeal denied or underpaid claims, tracking root causes to lower the practice's 15% denial trend. - Payer Communication: Follow up consistently with Medicare, commercial carriers, and Workers' Compensation adjusters to resolve outstanding aging balances. - Administrative Support & Systems Navigation - EMR Data Integrity: Document detailed coverage limits, authorization numbers, and billing updates accurately within the EMR. - Telephony Coordination: Utilize the Weave platform to manage inbound/outbound calls and text routing regarding patient financial clearings. - Schedule Adherence: Maintain highly reliable, independent productivity across a standard Monday through Friday, 8:00 AM – 5:00 PM PST shift. Qualifications - Experience: Minimum 2 years of dedicated medical billing, insurance verification, or authorization experience. - Specialty Knowledge: Background working within a Pain Management, Interventional Pain, Spine, Orthopedic, or Physical Medicine practice. - Language Proficiency: Exceptional written and verbal English communication skills for insurance negotiations and patient discussions. Preferred Skills - Direct experience with AdvancedMD (highly preferred) and/or Prognosis EMR systems. - Strong familiarity with billing rules for Medicare, commercial carriers, and Workers' Compensation. - Demonstrated track record of successfully reducing provider claim denials and improving reimbursement performance. Work Style - Analytical & Detail-Oriented: Catches formatting or diagnostic errors before claims leave the system. - Proactive Problem-Solver: Addresses authorization roadblocks early rather than waiting for a claim to deny. - Accountable: Takes complete ownership of core billing metrics with minimal supervision.
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Role Description Reporting to the Director, Enterprise Risk, the Lead, Insurance & Procurement Systems strengthens Girl Guides of Canada’s risk resilience by managing and optimizing GGC’s national insurance portfolio and building policies, controls, training, and oversight systems that support consistent, transparent, and compliant procurement and contract management across the organization. This role partners closely with various departments to design practical tools and processes that protect GGC’s people, assets, reputation, and mission. Qualifications - Post-secondary education in Risk Management, Insurance, Finance, Business Administration, Accounting, Public Administration, or related field, or equivalent experience. - 5+ years of progressive experience in risk management, insurance administration/brokerage, compliance, internal controls, or financial oversight. - Demonstrated experience managing insurance renewals, claims processes, and coverage analysis. - Experience designing and implementing policies, procedures, training, and monitoring/oversight processes. - Comfort working with sensitive matters with professionalism and discretion. - Ethical and trustworthy. - Insurance & contracting knowledge: ability to interpret policies and identify coverage gaps. - Policy development & change management: can build clear policies and drive adoption. - Analytical & systems thinking: comfortable with data, trends, dashboards, and designing scalable oversight mechanisms. - Communication & relationship skills: able to build trust with staff, volunteers, brokers, and insurers. - Values alignment: commitment to GGC’s mission and ability to work respectfully with diverse communities. - Enjoys solving puzzles. - Very strong attention to detail. - High levels of responsibility. Requirements - Lead the annual insurance renewal cycle: compile underwriting data, coordinate submissions, manage timelines, and prepare renewal recommendations. - Maintain strong broker and insurer relationships, ensuring service standards, responsiveness, and cost-effective solutions. - Assess coverage adequacy across lines and recommend adjustments based on exposure changes. - Coordinate claims support: intake and triage, documentation collection, liaison with broker/insurer, status tracking, and trend analysis. - Support incident reporting and risk controls by translating claims trends into practical prevention guidance. - Ensure policies and processes are clear and practical from the end-user perspective. - Be the point person for receiving, triaging and responding to insurance questions from Guiders. - Develop and maintain a Procurement System that includes core policies for staff and volunteers. - Provide initial vetting of medium and large contracts. - Create standard operating procedures, templates, and checklists for procurements. - Evaluate and modernize tools that strengthen transparency and reduce administrative burden. - Contribute to risk identification and assessment activities with emphasis on insurance and financial stewardship risks. - Prepare concise leadership-ready materials and support committee reporting as required. - Participate in business continuity and incident response planning. - Adhere to all relevant policies, procedures, and practices. - Apply organizational policies regarding diversity, inclusivity, and equity. - Embody and uphold GGC’s values, Code of Conduct, and mission. - Other duties as assigned. Benefits - Generous health benefits (Health, dental, vision, Health Service Spending Account). - Paid time off. - Collaborative remote work environment. - Fun and friendly work environment and work-life balance.
LICENCED LLQP Insurance Agents Virtual
AO NationAt AO Globe Life, our mission is simple: to protect families and change lives. Every day, our team shows up with purpose — meeting real people at some of the most important moments in their lives and making sure they have the protection they need. We believe that financial security should not be a privilege, it should be a right. Since 1951, we have been standing beside working families across North America, and as a subsidiary of Globe Life Inc. (NYSE: GL) — a Fortune 500, A+ rated company — we have the strength and stability to back that commitment for generations to come. When you join AO Globe Life, you are not just starting a job. You are joining a movement of people who believe their work matters.
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Consultant GKV Digitalization & Process Management / Statutory Health Insurance (all genders)
Dein Einstieg bei der ]init[ AGDu möchtest die Gesellschaft von morgen mitgestalten? Dann bist du bei ]init[ richtig. Denn unsere digitalen Lösungen sind für Menschen gemacht und haben gesellschaftliche Relevanz. Klingt spannend? Dann steig ein und arbeite gemeinsam mit über 1.400 ]init[s in interdisziplinären Teams an unseren sieben Standorten – oder flexibel von überall in Deutschland aus.
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Insurance & Risk Manager, Insurance Programs
Fresenius Medical CareCreating a future worth living. For patients. Worldwide. Every day.
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