The posting
Work From Anywhere in the Philippines
Work Schedule: PST | 8:00 AM – 4:00 PM, Monday to Friday
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.
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About the Client
A fast-growing US pediatric speech therapy practice is looking for a Revenue Cycle Specialist to own denials management and prior authorizations on the provider side.
Patient volume has grown faster than the current billing team can handle, so the practice is splitting its revenue cycle function into front-of-house and back-of-house roles. This hire owns the back-of-house side. Almost all of the practice’s authorizations go through Medicaid plans.
About the Role
About 70–80% of the work happens in the Candid clearinghouse. That includes appealing denied claims, fixing pre-submission issues like NPI setup and payer ID errors, and working the denial queue every day. The other 20–30% is submitting and tracking prior authorizations through an internal dashboard. Phone calls with patients, families, or payers happen occasionally, but most of the work is in the systems. The hire reports to the Head of RCM and works with little day-to-day oversight. Success means a shrinking backlog, which currently runs from 1,000 to 2,500 items, and better days in A/R, claim turnaround time, and clean claim rate.
Core Responsibilities
Denials Management & Claims Resolution
- Work denial queues daily in Candid and resolve each claim through appeal or correction.
- Draft and submit appeals for denied claims and track them to resolution.
- Fix pre-submission blockers such as incorrect NPI setup, missing payer IDs, and provider enrollment gaps.
- Correct claim data and resubmit claims to raise the clean claim rate.
- Find the root cause of recurring denials and apply fixes so they don’t happen again.
Prior Authorization Submission & Tracking
- Submit prior authorizations through the internal authorization dashboard, mostly for Medicaid plans.
- Track authorization status and follow up with payers until each request is approved or denied.
- Share authorization approvals and denials with providers and the scheduling team.
- Contact patients or families when an authorization needs more details or documents.
Reporting & Performance Monitoring
- Update the KPI dashboard for days in A/R, claim turnaround time, and clean claim rate.
- Send regular updates on backlog status and denial trends.
- Flag patterns in denials and authorizations and recommend process or system changes.
Requirements
Must-Have
- 2–5 years of provider-side healthcare revenue cycle experience at a practice, clinic, or outpatient provider (3+ years preferred; payer-side only does not qualify)
- Hands-on denials management experience: working denial queues, drafting appeals, and resubmitting corrected claims
- Hands-on prior authorization experience: submitting requests, tracking status, and following up with payers
- Experience with at least one clearinghouse or RCM platform (Candid Health, Waystar, Availity, Change Healthcare, Office Ally, or similar)
- Working knowledge of denial codes, NPI, payer IDs, and provider enrollment requirements
- Ownership of a denial or authorization queue in a prior role, with measurable results (e.g., backlog cleared, denial rate reduced, days in A/R lowered)
- C2 English (CEFR) for phone calls with patients, families, and insurance payers
Nice-to-Have
- Medicaid billing and prior authorization experience
- Billing experience for pediatric therapy services (speech, PT, or OT)
- CPT coding and EOB/ERA reading experience
- Team lead, supervisor, or trainer experience on a billing or RCM team
- Experience at a startup or high-growth healthcare practice
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
Ready to Join Us?
If you’re empathetic, organized, and passionate about improving patient experiences through operational excellence, this role is for you. Apply now to help make specialized healthcare more accessible to patients across the U.S.
