Medical Revenue Cycle Specialist – Pediatric Private Duty Nursing

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🔥 41 minutes ago

🇵🇭 Philippines – Remote

⏰ Full Time

🟡 Mid-level

🟠 Senior

✨ Revenue Cycle Specialist

👻 Ghost score 10%

What it means: the chance that no one is really hiring for this job.How to read it: 60% or higher means we think this is a ghost. Lower scores are less of a worry.How we score it: age, reposts, open roles vs team size, how fast jobs close, and whether pay is listed.Fine print: an estimate from public data, not a judgment of the company. Real jobs can score high, so treat it as a hint, not a fact.

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Peak Support

WebsiteLinkedInAll Job Openings

1001 - 5000 employees

📦 Logistics

📣 Marketing

🏥 Healthcare

Logistics • Marketing • Healthcare

Peak Support is a boutique Business Process Outsourcing (BPO) company, providing scalable solutions for customer service, technical support, sales, marketing, and back-office operations. With a presence in the Philippines, United States, Colombia, and Eastern Europe, they support fast-growing and innovative brands across multiple industries such as eCommerce, financial services, gaming, healthcare, and technology. Peak Support is dedicated to delivering exceptional quality and personalized attention by maintaining a highly skilled workforce and fostering a strong company culture. Their mission is to empower teams to innovate and exceed client expectations while ensuring data security and operational efficiency.

📋 Description

• Review new patient referrals and collect required demographic, insurance, and clinical information • Verify insurance eligibility, coverage, benefits, coordination of benefits, and authorization/SCA requirements • Obtain and document Care Manager contact information and verify discharge dates • Collect and review clinical documentation, including LOMNs, diagnoses, clinical notes, medical records, physician orders, and Form 485 • Prepare and submit authorization and reauthorization packets to insurance companies’ Utilization Management departments • Record submission dates, reference numbers, requested services, and authorization details • Monitor requests, follow up with payers, address outstanding requirements, and document determinations • Coordinate Single Case Agreements, reimbursement rate discussions, Gap Exceptions, appeals, and exception requests • Track authorization effective and expiration dates and begin reauthorization preparation at least two weeks before expiration • Maintain patient authorization records and set up applicable cases in AlayaCare and HHAeX • Communicate authorization details and approved hours to Scheduling and coordinate schedules with authorized service periods • Monitor compliance requirements, including nurse credentialing, EVV, authorized hours, and Care Manager approvals • Support dashboard reviews, exception resolution, pre-billing issue escalation, and patient status communications • Maintain trackers, reminders, follow-up logs, and case status records • Provide status updates, identify process issues, and recommend improvements • Escalate clinical support requests to licensed nurses and avoid making independent clinical determinations

🎯 Requirements

• Experience in medical billing, healthcare administration, insurance verification, medical revenue cycle management, or prior authorization • Familiarity with health insurance eligibility, benefits verification, authorization requirements, and payer follow-up processes • Strong organizational skills and ability to manage multiple patient cases and authorization deadlines simultaneously • Excellent written and verbal communication skills • Strong attention to detail when reviewing clinical documentation, authorization approvals, and patient records • Ability to track pending requests, follow up proactively, and escalate cases requiring timely resolution • Proficiency in maintaining spreadsheets, trackers, and electronic patient records • Ability to follow established procedures, maintain accurate documentation, and protect confidential patient information • Preferred: Experience supporting pediatric home health or Private Duty Nursing (PDN) • Preferred: Familiarity with NJ Medicaid and Medicaid Managed Care Organizations • Preferred: Experience using Availity, the NJ Medicaid Portal, AlayaCare, or HHAeX • Preferred: Familiarity with Letters of Medical Necessity, Form 485, Plans of Care, Single Case Agreements, and reauthorization workflows

🏖️ Benefits

• Fully remote work • Work-from-Home PLUS model • Positive, encouraging, and performance-driven culture • Opportunities to build rewarding, long-term careers • Tremendous opportunities for growth

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