Remote RCM Specialist

Pearl; Philippines; Remote; MXN 1,211,000 - 1,583,000; Full time

Benefits offered by this job

Remote work: fully remote

Global team exposure

Growth opportunities

Job summary

Pearl Talent is hiring a Revenue Cycle Management Specialist for a venture-backed virtual pediatric care company. The role runs day-to-day billing operations to keep insurance reimbursement and patient payments flowing on time.

This remote position supports eligibility verification, claims submission, payment posting, denials management, and patient collections for US commercial insurers and Medicaid, with a 9am-5pm PST schedule.

Qualifications

• 2+ years of US healthcare revenue cycle experience.
• Experience with eligibility and benefits verification, claims submission, payment posting, and denial management.
• Knowledge of CPT, ICD-10, and modifiers; PHI handling per HIPAA.
• Experience with payer portals and clearinghouses; HIPAA-compliant data handling.
• English CEFR level C1+ for live patient, family, and payer calls.

Responsibilities

• Verify insurance eligibility and benefits before visits and during follow-up.
• Submit claims within payer filing timelines and correct resubmissions.
• Post insurance and patient payments; reconcile and flag discrepancies.
• Follow up on unpaid or underpaid claims; manage denials and appeals.
• Explain coverage and billing to families; set up payment plans.
• Document all RCM activity following SOPs and HIPAA.

Skills

Revenue cycle

Eligibility verification

Claims submission

Payment posting

Denials management

HIPAA compliance

Payer portals

PHI handling

English C1+

Tools

Practice management system

Billing software

Clearinghouse software

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.

Requirements

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

Benefits

• 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

• Application
• Screening
• Skills Assessment
• Topgrading Interview
• Client Interview
• Job Offer
• Client Onboarding