# Virtual Medical Biller / Insurance Verification Specialist

> Staffing for Doctors · Philippines (Remote) · — · Posted 2026-06-15

**Workplace:** remote

## 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.

## Requirements

### Roles and Responsibilities

**1\. 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.

**2\. 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.

**3\. 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.

## Apply

[Apply at Staffing for Doctors](https://apply.workable.com/staffing-for-doctors/j/7C904781B0/apply)

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