Remote RCM Specialist
Pearl Talent
·- Location
- Central Luzon, Philippines · published · Central Visayas, Philippines · Bogotá, Bogota, Colombia · Metro Manila, Philippines · Medellín, Medellin, Colombia · Mexico City, Mexico City, Mexico
- Workplace
- Remote
- Type
- Full-time
- Department
- Healthcare
- Source
- Workable
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.