[Hiring] RCM Specialist @Pearl

Role Description

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.

Qualifications

• 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

Requirements

• CPB or CRCR certification (Nice-to-Have)
• Experience with Medicaid managed care plans (Nice-to-Have)
• Hands-on experience with a practice management or EHR system (Nice-to-Have)
• Pediatric, behavioral health, or telehealth billing experience (Nice-to-Have)
• Spanish fluency for patient and family outreach (Nice-to-Have)

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.