Remote Billing Specialist

Revenue Cycle Specialist

Work From Anywhere in the Philippines

Work Schedule: PST | 8:00 AM – 4:00 PM, Monday to Friday

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.

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 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

• 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.

• 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.

• 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.