Remote Pediatric Revenue Cycle Specialist

Peak Support Global Enterprise; Philippines; Remote; PHP 320,000 - 520,000; Full time

Benefits offered by this job

Remote work

Growth opportunities

Job summary

Peak Support Global Enterprise is seeking a Medical Revenue Cycle Specialist to manage insurance verification, authorizations, and Single Case Agreements for Pediatric Private Duty Nursing patients. You will track approvals, coordinate with Clinical and Scheduling teams, and ensure compliant documentation before services begin.

The role emphasizes accuracy, timely submissions, and payer follow-up, with remote work from home flexibility.

Qualifications

• Experience in medical billing, healthcare administration, and revenue cycle management.
• Familiarity with insurance eligibility, verification, and payer follow-up processes.
• Strong organizational, written, and verbal communication skills.

Responsibilities

• Review new patient referrals and collect demographic, insurance, and clinical information before initiating authorization requests.
• Verify eligibility, coverage dates, and primary/secondary insurance details; verify out-of-pocket responsibilities.
• Prepare and submit complete authorization packets to UM departments; record submission details and reference numbers.
• Monitor authorization requests and follow up with carriers to obtain determinations; identify SCA requirements and coordinate finalization.
• Coordinate with Clinical, Scheduling, Recruiting, Accounting, and Operations to support onboarding and continuity of care; ensure compliant documentation.
• Track authorizations, expirations, and reauthorizations; begin reauthorization at least two weeks before expiry; coordinate with clinical notes and Plans of Care.
• Coordinate appeals and collect updated clinical documentation; escalate delays or denials; ensure proper LOMNs, Form 485, and related records.
• Set up patient records in systems (AlayaCare, HHAeX) and ensure accurate authorization data; communicate updates to scheduling and care teams.
• Maintain accurate authorization trackers, reminders, and case status; support dashboard reviews and pre-billing issue escalation.

Skills

Medical billing

Healthcare administration

Insurance verification

Revenue cycle management

Prior authorization

Organizational skills

Communication skills

Attention to detail

Documentation compliance

Data tracking

Tools

Availity

NJ Medicaid Portal

AlayaCare

HHAeX

Job description

Peak Support Global Enterprise is seeking a Medical Revenue Cycle Specialist to manage insurance verification, authorizations, and Single Case Agreements for Pediatric Private Duty Nursing patients. You will track approvals, coordinate with Clinical and Scheduling teams, and ensure compliant documentation before services begin.

The role emphasizes accuracy, timely submissions, and payer follow-up, with remote work from home flexibility.