RCM Specialist
New
P
Pearl TalentHealthcare billing
Work From Anywhere in LATAM or the Philippines, 9AM - 5PM PSTFull-TimeJunior
Salary not disclosed
Apply NowOpens the employer's application page
Job Details
- Languages
- English at C1+ CEFR level for live patient, family, and payer calls
- Experience
- 2+ years of hands-on US healthcare revenue cycle or medical billing experience
Requirements
- Have 2+ years of hands-on US healthcare revenue cycle or medical billing experience.
- Have hands-on experience with eligibility and benefits verification, claims submission, payment posting, claims follow-up, and denial management.
- Know US commercial insurance and Medicaid, including copays, deductibles, coinsurance, and network status.
- Know CPT, ICD-10, and modifiers for claim review and validation.
- Have experience posting payments from ERAs and EOBs, including adjustments, denials, and deposit reconciliation.
- Have hands-on experience using payer portals, clearinghouses, and billing platforms.
- Handle protected health information in accordance with HIPAA requirements.
- Have English proficiency at C1+ CEFR level for live patient, family, and payer calls.
- CPB or CRCR certification is preferred.
- Experience with Medicaid managed care plans is preferred.
- Experience with a practice management or EHR system is preferred.
- Pediatric, behavioral health, or telehealth billing experience is preferred.
- Spanish fluency for patient and family outreach is preferred.
Responsibilities
- Verify insurance eligibility and benefits before visits, claim submission, and follow-up; investigate coverage issues and document results.
- Validate demographics, insurance details, CPT and ICD-10 codes, modifiers, and place of service before submitting claims.
- Submit claims within payer filing requirements, monitor acknowledgments, and correct and resubmit rejected claims.
- Post insurance and patient payments, adjustments, and denials from ERAs and EOBs; reconcile payments against deposits and remittance totals.
- Follow up on unpaid, pending, and underpaid claims through payer portals; complete corrections, reconsiderations, and appeals.
- Track denial trends and recovery outcomes, flag recurring issues, and escalate complex claims to the Team Lead.
- Explain coverage, benefits, and expected costs to patients and families; conduct outreach on outstanding balances and arrange payments within guidelines.
- Respond to billing inquiries by phone, email, and patient portal.
- Document RCM activity according to SOPs, payer guidelines, and HIPAA requirements; meet productivity, quality, and turnaround targets.
- Recommend workflow improvements based on recurring billing issues.
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