Medical Billing Specialist / Insurance Claims Verifier - A157

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 EST

Locations:

• LATAM: Mexico City (Mexico), Bogotá (Colombia), São Paulo (Brazil), Buenos Aires (Argentina)
• Philippines: Manila, Cebu, Davao — with reliable MST overlap

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. 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: WATCH HERE

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 Overview

The 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.

In this role, the Medical Billing Specialist / Insurance Claims Verifier is responsible for ensuring accurate insurance verification, efficient claim submission, and timely billing resolution so families receive clarity in their care costs and providers can deliver care without disruption.

The ideal candidate is detail-oriented, reliable, comfortable communicating with payers and families, and experienced in end-to-end medical billing workflows.

Your Impact:

Your accuracy and communication will directly support the clinic’s mission of delivering uninterrupted, high-quality care. By maintaining smooth billing operations and resolving claims efficiently, you ensure that both families and providers experience a transparent and stress-free financial process.

Core Responsibilities

Insurance Verification & Patient Cost Estimates – 35%

• 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 in a clear, supportive, and timely manner.
• Confirm in-network status and coordinate with credentialing as needed.

Authorizations & Referral Management – 25%

• 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 – 30%

• 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 – 10%

• Confirm provider notes are submitted on time and meet billing documentation standards.
• Serve as the primary contact for patient billing questions via email/tickets.
• Ensure responses are clear, empathetic, and consistent with billing policies.

Must-Haves (Required)

• Proven experience in medical billing, insurance verification, and claims processing.
• Familiarity with CPT codes, coverage rules, authorizations, and denial workflows.
• Comfortable communicating with insurance payers and families regarding billing matters.
• Strong organizational skills with the ability to track multiple ongoing cases.
• Ability to work independently and maintain consistent attention to detail.

Nice-to-Haves (Preferred)

• Experience working in behavioral health, speech therapy, or outpatient clinic settings.
• Experience using multiple EMRs simultaneously.
• Background working in a fully remote operations environment.

Tools Proficiency

Required:

• 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