Remote RCM Specialist

Pearl; Central Luzon; Remote; PHP 3,781,000 - 5,671,000; Full time

Benefits offered by this job

Remote work

Generous PTO

Health coverage for PH-based talents

Direct mentorship

Learning & Development

Global networking

Job summary

Pearl Talent is recruiting a Revenue Cycle Management Specialist to run day-to-day billing operations for a venture-backed pediatric care client. This fully remote role handles eligibility, submissions, denials, and patient collections, interfacing with payers and families across multiple US states.

You will ensure clean claims and timely reimbursement while maintaining HIPAA-compliant practices. The position offers remote work from anywhere, competitive salary, and opportunities for mentorship

Qualifications

• 2+ years of hands-on US healthcare revenue cycle or medical billing experience
• Experience across eligibility and benefits verification, claims submission, payment posting, claims follow-up, and denial management
• Working knowledge of US commercial insurance and Medicaid, including copays, deductibles, coinsurance, and network status
• Knowledge of CPT, ICD-10, and modifiers for claim review and validation
• Payment posting from ERAs and EOBs, including adjustments, denials, and deposit reconciliation
• HIPAA-compliant handling of PHI using payer portals, clearinghouses, and billing platforms
• English at C1+ CEFR level for live patient, family, and payer calls

Responsibilities

• Verify insurance eligibility and benefits before visits, before claim submission, and during follow-up
• Submit claims within payer timely filing requirements
• Monitor clearinghouse and payer acknowledgments, and correct and resubmit rejected claims
• Post insurance payments, adjustments, and denials from ERAs and EOBs
• Post patient payments and reconcile with deposits and remittance totals
• Follow up on unpaid, pending, and underpaid claims through payer portals
• Identify denial root causes and complete corrections, resubmissions, reconsiderations, and appeals
• Explain coverage and costs to patients and families based on verified benefits
• Document all RCM activity in designated systems following SOPs and HIPAA
• Meet productivity, quality, and turnaround-time targets
• Suggest workflow improvements based on recurring issues

Skills

US healthcare revenue cycle

Medical billing

CPT/ICD-10 knowledge

HIPAA compliance

PHI handling

English proficiency

Tools

Payer portals

Clearinghouses

Billing platforms

Job description

Work From Anywhere in LATAM or the Philippines

Work Schedule: 9AM - 5PM PST

About Pearl Talent

Pearl works with the top 1% of candidates from around the world and connects them with the best startups in the US and EU. Our clients have raised over $5B in aggregate and are backed by companies like OpenAI, a16z, and Founders Fund.

Hear why we exist, what we believe in, and who we’re building for:
Watch here: https://www.loom.com/share/863b8e426e6d48309aa8f4ea4c1c94cd

About the Client

A venture-backed virtual pediatric care company is looking for a Revenue Cycle Management Specialist to run day-to-day billing operations and keep insurance reimbursement and patient payments flowing on time.

The company delivers virtual, multi-specialty care for children with chronic conditions such as ADHD and anxiety, with referrals coming from pediatricians across multiple US states. It is in-network with major commercial insurers, serves both commercial and Medicaid families, and recently raised a Series A to expand into new care areas.

About the Role

The RCM Specialist owns the revenue cycle from insurance verification and claims submission through payment posting, claims follow-up, denials, and patient collections, reporting to the Team Lead. The role works directly with patients, families, payers, and internal teams to resolve billing and reimbursement issues. Success means clean claims, faster reimbursement, fewer repeat denials, and a clear billing experience for families.

Core Responsibilities

Eligibility & Benefits Verification

• Verify insurance eligibility and benefits before visits, before claim submission, and during follow-up.
• Confirm copays, deductibles, coinsurance, out-of-pocket maximums, and in-network status.
• Investigate inactive policies, coverage limits, and discrepancies.
• Document verification results accurately in designated systems.

Claims Submission

• Validate demographics, insurance details, CPT and ICD-10 codes, modifiers, and place of service before submission.
• Submit claims within payer timely filing requirements.
• Monitor clearinghouse and payer acknowledgments, and correct and resubmit rejected claims.
• Route coding questions to the designated reviewer.

Payment Posting

• Post insurance payments, adjustments, and denials from ERAs and EOBs.
• Post patient payments according to billing and collection procedures.
• Reconcile posted payments against deposits and remittance totals.
• Flag underpayments and overpayments against expected reimbursement.

Claims Follow-up, Denials & Appeals

• Follow up on unpaid, pending, and underpaid claims through payer portals.
• Identify denial root causes and complete corrections, resubmissions, reconsiderations, and appeals.
• Track denial trends and recovery outcomes, and flag recurring payer, coding, or eligibility issues.
• Escalate complex or unresolved claims to the Team Lead.

Patient Billing & Collections

• Explain coverage, benefits, and expected costs to patients and families based on verified benefits.
• Conduct outreach on outstanding copays, coinsurance, deductibles, and self-pay balances.
• Set up payment arrangements within approved guidelines.
• Respond to billing inquiries by phone, email, and patient portal.

Documentation & Quality

• Document all RCM activity in designated systems following SOPs, payer guidelines, and HIPAA requirements.
• Meet assigned productivity, quality, and turnaround-time targets.
• Recommend workflow improvements based on recurring billing issues.

Must-Have

• 2+ years of hands-on US healthcare revenue cycle or medical billing experience
• Hands-on experience across eligibility and benefits verification, claims submission, payment posting, claims follow-up, and denial management
• Working knowledge of US commercial insurance and Medicaid, including copays, deductibles, coinsurance, and network status
• Working knowledge of CPT, ICD-10, and modifiers for claim review and validation
• Payment posting from ERAs and EOBs, including adjustments, denials, and deposit reconciliation
• Hands-on use of payer portals, clearinghouses, and billing platforms, with HIPAA-compliant handling of PHI
• English at C1+ CEFR level for live patient, family, and payer calls

Nice-to-Have

• CPB or CRCR certification
• Experience with Medicaid managed care plans
• Hands-on experience with a practice management or EHR system
• Pediatric, behavioral health, or telehealth billing experience
• Spanish fluency for patient and family outreach

• Competitive Salary: Based on experience and skills

• Remote Work: Fully remote—work from anywhere
• Team Incentives: Recognition for maintaining 100% CRM hygiene and on-time reporting
• Generous PTO: In accordance with company policy
• Health Coverage for PH-based talents: HMO coverage after 3 months for full-time employees
• Direct Mentorship: Guidance from international industry experts
• Learning & Development: Ongoing access to resources for professional growth
• Global Networking: Connect with professionals worldwide

Our Recruitment Process

1. Application
2. Screening
3. Skills Assessment
4. Topgrading Interview
5. Client Interview
6. Job Offer
7. Client Onboarding