Remote Medical Revenue Cycle Specialist - Pediatric PDN

Peak Support; Taguig; À distance; PHP 446 000 - 781 000; Plein temps

Avantages offerts par ce poste

Remote work

Growth opportunities

Résumé du poste

Peak Support in the Philippines is seeking a Medical Revenue Cycle Specialist for Pediatric Private Duty Nursing (PDN). You will manage verification, authorizations, SCAs, and reauthorizations, ensuring documentation is complete and approvals are secured before services begin.

You will collaborate with Sales, Intake, Clinical, Scheduling, Recruiting, Accounting, and Operations to support onboarding, accurate authorization records, and payer compliance.

Qualifications

• Experience in medical billing, healthcare administration, insurance verification, medical revenue cycle management, or prior authorization.
• Familiarity with health insurance eligibility, benefits verification, authorization requirements, and payer follow-up processes.
• Strong organizational skills and the ability to manage multiple patient cases and authorization deadlines simultaneously.
• Excellent written and verbal communication skills for coordinating with insurance carriers and internal teams.
• Strong attention to detail when reviewing clinical documentation, authorization approvals, and patient records.
• Ability to track pending requests, follow up proactively, and elevate cases requiring timely resolution.
• Proficiency in maintaining spreadsheets, trackers, and electronic patient records.
• Ability to follow established procedures, maintain accurate documentation, and protect confidential patient information.

Responsabilités

• New Case Intake and Insurance Verification: Review new patient referrals and ensure all required demographic, insurance, and clinical information is collected before initiating authorization requests.
• Authorization and Single Case Agreement (SCA) Management: Collect and review required clinical documentation, coordinate with Clinical team, submit packets to UM departments, and monitor determinations.
• Reauthorization and Authorization Expiration Tracking: Maintain tracking system for authorization dates, prepare reauthorizations, and coordinate with Clinical team.
• Appeals and Clinical Documentation Coordination: Collect updated documentation for appeals and exceptions, coordinate with Clinical team, and escalate unresolved items.
• Patient System Setup and Authorization Documentation: Ensure documentation is maintained in systems, coordinate patient setup in AlayaCare and HHAeX NJ Medicaid cases, and communicate approvals to Scheduling.
• Compliance Monitoring and Operational Support: Monitor payer requirements, ensure nurse credentialing, EVV compliance, and daily dashboard reviews.
• Reporting and Process Improvement: Maintain trackers, reminders, and provide updates on authorization status and potential risks.

Connaissances

Insurance verification

Prior authorization

Medical billing

Revenue cycle management

Benefits verification

Payer follow-up

Documentation review

Communication skills

Organization

Outils

Availity

NJ Medicaid Portal

AlayaCare

HHAeX

Description du poste

Peak Support in the Philippines is seeking a Medical Revenue Cycle Specialist for Pediatric Private Duty Nursing (PDN). You will manage verification, authorizations, SCAs, and reauthorizations, ensuring documentation is complete and approvals are secured before services begin.

You will collaborate with Sales, Intake, Clinical, Scheduling, Recruiting, Accounting, and Operations to support onboarding, accurate authorization records, and payer compliance.