Healthcare billing operations lead - a157Pearl Talent

Work Arrangement: Fully Remote - Working 9:00 AM - 5:00 PM EST
Job Type: Independent Contractor, Full-time
Work Schedule: Monday to Friday | 9:00 AM - 5:00 PM ESTLocations:
LATAM: Mexico City (Mexico), Bogotá (Colombia), São Paulo (Brazil), Buenos Aires (Argentina)
Philippines: Manila, Cebu, Davao - with reliable MST overlap
About Pearl TalentPearl 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. They're looking for the sharpest, hungriest candidates who they can consistently promote and work with over many years. Candidates we've hired have been flown out to the US and EU to work with their clients, and even promoted to roles that match folks onshore in the US.Hear why we exist, what we believe in, and who we're building for:Why Work with Us?
At Pearl, we're not just another recruiting firm-we connect you with exceptional opportunities to work alongside visionary US and EU founders. Our focus is on placing you in roles where you can grow, be challenged, and build long-term, meaningful careers.Role OverviewThe company is a growing therapy group providing speech therapy services to children and families. We collaborate closely with providers and caregivers to deliver coordinated care and maintain a supportive, patient-first experience.As the Healthcare Billing Operations Lead, you will oversee a small team of billing specialists and claims verifiers, ensuring accurate insurance verification, efficient claim submission, and timely resolution of billing issues. You will act as a subject matter expert (SME) for billing workflows, coach team members, review their work for accuracy, and serve as the escalation point for complex payer and patient inquiries.The ideal candidate is detail-oriented, reliable, comfortable communicating with payers, families, and internal staff, and experienced in end-to-end medical billing operations with a demonstrated leadership background.Your Impact:Your leadership and accuracy will directly support the clinic's mission of delivering uninterrupted, high-quality care. By managing your team effectively and resolving claims efficiently, you will ensure that both families and providers experience a transparent and stress-free financial process.Core ResponsibilitiesTeam Leadership & Oversight - 20%
Manage, mentor, and coach a team of billing specialists and claims verifiers.
Review team work for accuracy and compliance with billing policies.
Serve as escalation point for complex billing or insurance issues.
Ensure workflows are standardized and followed across the team.
Insurance Verification & Patient Cost Estimates - 30%
Verify insurance eligibility and benefits using Availity and payer portals.
Contact insurance companies for coverage clarification and policy details.
Generate accurate cost estimates for evaluations and ongoing care.
Communicate estimates to families clearly and empathetically.
Confirm in-network status and coordinate with credentialing as needed.
Authorizations & Referral Management - 20%
Submit prior authorization and referral requests for services requiring approval.
Track authorization limits, expirations, and visit usage for ongoing treatment.
Communicate authorization status updates with providers and administrative staff.
Resubmit authorizations or follow up on pending determinations to prevent service disruption.
Billing & Claims Processing - 25%
Enter and reconcile patient charges across two EMR systems.
Manage copays, co-insurance, and upfront evaluation payments.
Resolve claim errors that prevent submission and address payer denials.
Conduct denial research, correct claim issues, and resubmit as necessary.
Coordinate with clearinghouse and coding as needed and complete write-offs per policy.
Documentation Validation & Patient Communications - 5%
Confirm provider notes are submitted on time and meet billing documentation standards.
Serve as primary contact for patient billing questions via email/tickets.
Ensure responses are clear, empathetic, and consistent with billing policies.
RequirementsMust-Haves:
Previous experience managing a team in healthcare billing, claims, or a related field (SME, Supervisor, Team Lead).
Strong knowledge of insurance verification, billing, and claim workflows.
Excellent written and verbal communication skills.
Detail-oriented with strong organizational and ownership mindset.
Comfortable in fast-paced, high-volume, and ambiguous environments.
Nice-to-Haves:
Experience with multiple EMR systems and clearinghouse software.
Knowledge of pediatric therapy billing procedures.
Experience training or mentoring new billing staff.
Tools ProficiencyRequired:
Availity (insurance verification)
EMRs (ability to learn and manage multiple systems)
Payer portals and claims submission platforms
Email and ticket-based communication systems
Preferred:
Candid or similar billing systems
Clearinghouse claim management platforms
Benefits
Competitive Salary: Based on experience and skills
Remote Work: Fully remote-work from anywhere
Performance Bonus: Based on data accuracy, reporting timeliness, and overall sales efficiency
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
Top-grading Interview
Client Interview
Job Offer
Client Onboarding
Ready to Join Us?If this role aligns with your skills and goals, apply now to take the next step in your journey with Pearl.
Pearl Talent

Central Visayas
Contract
Full-time