Position Type: Full Time
Location: Philippines (Remote)
Schedule:
Monday to Thursday: 8AM to 4PM CST (9 PM to 5 AM PH Time)
Friday: 8AM to 2PM CST (9 PM to 3 AM PH Time)
Salary range: Php 45,000-57,000/month
About the Company
Our client is a leading ophthalmology clinic based in Texas with 17 locations and over 50 doctors. They are committed to employee fulfillment and career growth, guided by their core values: integrity, respect, empathy, accountability, compassion, and honesty.
About the Role
The Remote Insurance Verification & Patient Cost Estimate Specialist is responsible for verifying insurance benefits and preparing accurate, comprehensive patient cost estimates for cataract surgery services, including both professional (surgeon) and facility (ambulatory surgery center) components. This role supports a high-volume ophthalmology practice and plays a key part in delivering financial transparency to patients, particularly related to standard cataract procedures.
This role is critical to ensuring cataract patients clearly understand both their insurance-covered benefits and corresponding out-of-pocket costs. By providing accurate estimates and thoughtful financial guidance, this position improves patient trust, increases acceptance of premium services, and reduces billing surprises—supporting both patient satisfaction and organizational performance.
Responsibilities
Insurance Verification (Cataract-Specific)
- Verify eligibility and benefits for cataract surgery procedures (e.g., CPT 66984 and related services)
- Confirm and document:
- Deductibles and remaining balances
- Out-of-pocket maximums
- Copayments and coinsurance
- In-network vs. out-of-network status for surgeon and surgery center
- Co-management with the referring physician
- Identify prior authorization or referral requirements (when applicable)
- Accurately enter and update insurance details in the practice management system
Patient Cost Estimation
- Prepare detailed, patient-friendly estimates for:
- Surgeon/professional fees
- Facility (ASC) fees
- Ancillary services (e.g., Ascan)
- Apply payer-specific contracted rates and Medicare guidelines to estimate allowed amounts
- Calculate patient responsibility based on real-time benefits
- Clearly reflect which services are covered by insurance vs non-covered
Coordination with Clinical & Administrative Teams
- Request contracted insurance reimbursement for plans not listed on the estimator tool.
- Request a copy of the missing insurance cards and place them in the patient's chart
- Communicate any unique insurance or financial issues, not reflected on the patient estimate, with the patient counselors.
Remote Workflow & Documentation
- Work efficiently in a fully remote environment using EMR, practice management systems, and payer portals
- Maintain accurate, real-time documentation of all verification and estimate details
- Meet productivity and turnaround time expectations for a high-volume cataract surgery schedule
- Maintain organization of many patient estimates.
Compliance & Accuracy
- Ensure compliance with Medicare guidelines and commercial payer policies specific to cataract surgery
- Maintain strict adherence to HIPAA and data security protocols in a remote setting
- Minimize estimate-to-actual variance through thorough verification and documentation
Competencies and Qualifications
Education & Experience
- High school diploma or equivalent required; college coursework preferred
- 2+ years of experience in insurance verification, patient access, or revenue cycle
- Ophthalmology and cataract surgery experience is a plus
- Experience with ASC and professional billing preferred
- Prior remote work experience preferred
- Excel experience and basic understanding of Excel a must.
Knowledge & Skills
- Strong understanding of:
- Medicare and commercial insurance plans
- Math, including addition, subtraction, and multiplication of percentages. Strong math skill orientation necessary.
- HIPAA and patient confidentiality
- Familiarity with CPT, ICD-10, and payer reimbursement structures
- Excellent attention to detail and analytical skills
- Good phone and written communication skills related to benefits verification and patient estimates
- High level of comfort working independently in a remote environment
- Proficiency with EMR/practice management systems, payer portals, and Excel
Key Performance Indicators (KPIs):
- Insurance verification accuracy rate
- Estimate accuracy (variance to actual patient responsibility)
- Turnaround time for completed estimates
- Patient and counselor satisfaction with financial communication
Work Environment:
- Fully remote position
- Requires a secure, HIPAA-compliant home workspace and reliable high-speed internet
- Heavy computer-based work with some phone work
- Alignment with clinic and surgery center schedules across time zones as needed
What We Offer
- 100% Remote Work
- 13th Month Pay
- Healthcare (HMO)
- Comprehensive Fringe Benefits package
- Paid Service Incentive Leave (SIL)
- Paid Philippines Holidays
- Free Learning and Development Programs
Application Process
We understand that searching for a new job can be challenging, and we're here to support you every step of the way. Our goal is to make the process as transparent and respectful as possible.
Typically, the interview process includes a Recruiter Interview and Client Interview, but this may vary depending on the role. Throughout each stage, we'll keep you informed and provide feedback as quickly as we can, ensuring you feel valued and supported throughout your journey with us.
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