Job Overview
Location
Remote
Job Type
Full-time
Category
Software Engineering
Date Posted
February 26, 2026
Full Job Description
đź“‹ Description
- • As the Healthcare Billing Operations Lead, you will be instrumental in ensuring the smooth and efficient financial operations of a growing therapy group dedicated to providing speech therapy services to children and families. This pivotal role involves leading a small, dedicated team of billing specialists and claims verifiers, acting as a subject matter expert, and driving best practices in all aspects of healthcare billing. Your leadership will directly impact the clinic's ability to deliver uninterrupted, high-quality care by ensuring a transparent, accurate, and stress-free financial experience for both families and providers.
- • In this capacity, you will be responsible for overseeing the entire revenue cycle, from initial insurance verification and patient cost estimation to claim submission, denial management, and patient communication. You will manage, mentor, and coach your team, fostering a collaborative and high-performing environment. A key aspect of your role will be reviewing the team's work for accuracy and compliance, ensuring adherence to established billing policies and procedures. You will also serve as the primary escalation point for complex billing, insurance, or payer-related issues, leveraging your expertise to find timely and effective resolutions.
- • A significant portion of your responsibilities will focus on insurance verification and providing accurate patient cost estimates. This involves utilizing tools like Availity and various payer portals to verify insurance eligibility and benefits, and proactively contacting insurance companies to clarify coverage details and understand policy nuances. Based on this information, you will generate clear and empathetic cost estimates for both initial evaluations and ongoing therapy services, communicating these effectively to families. You will also be responsible for confirming the in-network status of providers and coordinating with the credentialing team as necessary to ensure seamless billing processes.
- • Furthermore, you will manage the critical processes of prior authorization and referral management. This includes submitting requests for services that require pre-approval, diligently tracking authorization limits, expiration dates, and the number of visits used for ongoing treatment. You will maintain open lines of communication with providers and administrative staff, providing timely updates on authorization statuses and proactively addressing any potential disruptions to care by resubmitting requests or following up on pending determinations.
- • Your role extends to the core functions of billing and claims processing. You will be responsible for accurately entering and reconciling patient charges across two distinct Electronic Medical Record (EMR) systems. This includes managing copays, co-insurance, and upfront payments for evaluations. A crucial element of this is resolving claim errors that prevent submission and meticulously addressing and resolving payer denials. You will conduct thorough denial research, identify the root causes of claim rejections, correct the necessary information, and resubmit claims. Coordination with the clearinghouse and coding teams will be essential, along with completing write-offs in accordance with established policies.
- • Finally, you will play a role in documentation validation and patient communications. This involves confirming that provider notes are submitted promptly and meet all necessary billing documentation standards. You will also serve as the primary point of contact for patient billing inquiries received via email tickets, ensuring that all responses are clear, empathetic, and consistently aligned with the clinic's billing policies and procedures. Your attention to detail and commitment to excellent service will ensure that families feel supported and informed throughout their billing journey.
🎯 Requirements
- • Proven experience in end-to-end medical billing operations, with a strong understanding of the revenue cycle, insurance verification, claims submission, and denial management.
- • Demonstrated leadership experience, including managing, mentoring, and coaching a team.
- • Proficiency with medical billing software and platforms, specifically Availity and various payer portals.
- • Excellent communication and interpersonal skills, with the ability to interact effectively with payers, families, internal staff, and providers.
- • Detail-oriented, organized, and reliable, with a strong ability to manage multiple tasks and prioritize effectively.
🏖️ Benefits
- • Fully Remote Work Arrangement
- • Independent Contractor, Full-time Position
- • Opportunity to work with leading US and EU startups backed by top-tier investors.
- • Potential for career growth and advancement within client organizations.
Skills & Technologies
Senior
Remote
About Pearltalent
Pearltalent is a recruitment and talent acquisition firm specializing in connecting companies with top-tier professionals across various industries. They offer a comprehensive suite of services, including executive search, contingent staffing, and RPO (Recruitment Process Outsourcing) solutions. Their expertise lies in understanding specific client needs and sourcing candidates with the right skills, experience, and cultural fit. Pearltalent focuses on building long-term partnerships with both employers and job seekers, aiming to streamline the hiring process and ensure successful placements. They leverage technology and a deep understanding of the labor market to deliver efficient and effective talent solutions.
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