Healthcare VA, Benefits & Reimbursement Specialist WFH GY SHIFT

osition: Healthcare Virtual Assistant, Benefits and Reimbursement Specialist
Work Arrangement: 100% Remote
Employment Type: Full-Time
Job Summary
We are looking for a detail-oriented and organized Remote Healthcare Virtual Assistant specializing in insurance benefits verification, reimbursement processing, and medical billing support.
The ideal candidate will have experience working with healthcare providers, insurance companies, and medical billing systems. This role involves verifying patient insurance coverage, checking benefits and eligibility, monitoring claims, following up on reimbursements, and assisting with insurance-related administrative tasks.
The primary goal is to ensure accurate insurance information, timely reimbursement, and efficient communication between healthcare providers, patients, and insurance companies.
Key Responsibilities
1. Insurance Benefits Verification
Verify patient insurance eligibility and active coverage.
Confirm benefits, deductibles, copayments, coinsurance, and out-of-pocket maximums.
Check coverage limitations, exclusions, and authorization requirements.
Contact insurance companies to confirm patient benefits and coverage details.
Document verification results accurately in patient records.
Identify potential insurance coverage issues before scheduled appointments or procedures.
2. Claims and Reimbursement Management
Monitor submitted medical claims and reimbursement status.
Follow up with insurance companies regarding pending, unpaid, or denied claims.
Review Explanation of Benefits (EOB) and Electronic Remittance Advice (ERA).
Investigate reimbursement discrepancies and underpaid claims.
Assist with claim corrections, reconsiderations, and appeals.
Track outstanding reimbursements and maintain accurate follow-up records.
Coordinate with medical billing teams to resolve payment issues.
3. Prior Authorization and Insurance Coordination
Determine whether medical services require prior authorization.
Assist with submitting authorization requests and supporting documentation.
Follow up on pending authorization approvals.
Maintain accurate authorization records and expiration dates.
Coordinate with healthcare providers and insurance representatives to resolve coverage concerns.
4. Patient and Provider Communication
Respond professionally to patient questions regarding insurance benefits and reimbursement.
Explain insurance coverage, patient financial responsibility, and claim status.
Communicate with healthcare providers regarding insurance-related concerns.
Contact insurance representatives to resolve claims and payment discrepancies.
Maintain confidentiality of patient and insurance information.
5. Administrative and Reporting Tasks
Update patient insurance information in Electronic Health Record (EHR) systems.
Maintain organized records of benefits verification and reimbursement activities.
Prepare daily and weekly reports on pending claims, denied claims, and reimbursement status.
Monitor outstanding insurance balances and follow-up deadlines.
Support other healthcare administrative and billing tasks as assigned.
Required Qualifications
At least 1–2 years of experience as a Healthcare Virtual Assistant, Insurance Verification Specialist, Medical Billing Specialist, or similar role.
Experience verifying U.S. healthcare insurance benefits and eligibility.
Knowledge of medical claims processing and reimbursement procedures.
Familiarity with Medicare, Medicaid, and commercial insurance plans.
Understanding of medical billing terminology, CPT codes, ICD-10 codes, and HCPCS codes.
Experience reviewing EOBs, ERAs, and insurance claim denials.
Familiarity with EHR/EMR systems and insurance provider portals.
Strong written and verbal English communication skills.
Excellent attention to detail, organization, and problem-solving abilities.
Ability to work independently in a remote environment.
Understanding of HIPAA regulations and patient confidentiality requirements.
Preferred Qualifications
Experience working with U.S.-based healthcare providers or medical billing companies.
Familiarity with insurance portals such as Availity, UnitedHealthcare, Aetna, Cigna, and Medicare.
Experience with claims follow-up, denial management, and accounts receivable.
Knowledge of prior authorization and medical necessity requirements.
Proficiency in Microsoft Excel, Google Sheets, and healthcare practice management software.
Key Performance Indicators (KPIs)
Performance will be measured through:
Benefits Verification Accuracy: Target of 98% or higher.
Verification Turnaround: Complete routine insurance verification within 24 hours or before scheduled appointments.
Claims Follow-Up: Review and follow up on assigned outstanding claims within established deadlines.
Reimbursement Tracking: Maintain accurate and updated reimbursement records.
Denial Resolution: Reduce unresolved denied claims through timely follow-up and proper documentation.
Documentation Accuracy: Maintain complete and accurate records of insurance communications and claim updates.
Productivity: Meet assigned daily and weekly workload targets while maintaining quality standards.
Work Requirements
Reliable high-speed internet connection.
Quiet, professional, and private home workspace.
Computer capable of running healthcare management applications.
Availability to work during designated U.S. business hours.
Ability to handle sensitive patient information using approved, secure systems.
Ideal Candidate
The ideal candidate is proactive, dependable, highly organized, and experienced in navigating U.S. healthcare insurance processes. They can independently verify benefits, identify reimbursement issues, communicate effectively with insurance representatives, and help healthcare providers maintain consistent cash flow through accurate and timely claims management.

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