US Healthcare Revenue Cycle Specialist — Benefits, Prior Authorization & Billing Support

TRUBRIETY is a growing U.S.-based behavioral health practice providing outpatient and intensive outpatient treatment for mental health and substance use conditions.

We are looking for an experienced **Healthcare Revenue Cycle Management (RCM) Specialist** in the Philippines who wants a long-term role and can grow with our company.

This is not a general virtual assistant position.

We are specifically looking for someone with hands-on experience working with **U.S. healthcare insurance, benefits verification, prior authorization, medical billing, claims, or revenue cycle management.**

The position will initially focus heavily on **insurance eligibility/benefits verification and prior authorization**, then expand into broader revenue-cycle and healthcare operations responsibilities as our patient volume grows.

## Schedule

Approximately **4 hours/day, 3 days/week — 12 hours/week** to start.

We expect this role to grow toward **20–40 hours/week** as TRUBRIETY grows.

Some working hours must overlap with **U.S. Pacific Time business hours** because you will need to call insurance companies and work with payer portals.

## Initial Responsibilities

Your first priority will be making sure new insured patients are financially cleared before treatment whenever possible.

For each patient, you will verify and accurately document:

* Active insurance coverage
* In-network/out-of-network status
* Behavioral health benefits
* Mental health and substance use benefits
* Deductible and amount met
* Out-of-pocket maximum and amount met
* Copay
* Coinsurance
* Coverage for anticipated services
* Whether prior authorization is required
* Authorization requirements
* Visit/day limits
* Payer representative name
* Call/reference number
* Exclusions or unusual coverage issues

You will enter this information accurately into **SimplePractice** and our insurance tracking system.

Our goal is to clearly know where every patient stands:

**Benefits Verified → PA Required/Not Required → PA Submitted → PA Approved → Ready for Services/Billing**

## Prior Authorization Responsibilities

As you demonstrate accuracy, you will also:

* Initiate prior authorization requests
* Submit administrative information and clinical documentation supplied by our clinical team
* Call payers regarding authorization status
* Follow up on pending authorizations
* Track authorization numbers
* Track approved visits/days
* Track authorization dates and expiration dates
* Identify additional information requested by payers
* Alert the team before authorizations expire
* Document payer responses and reference numbers

## Revenue Cycle Responsibilities

The position will expand into broader RCM responsibilities, including:

* Checking claim status
* Researching unpaid claims
* Researching denials and rejection reasons
* Identifying missing information
* Calling payers regarding claim issues
* Tracking accounts receivable follow-up
* Maintaining outstanding claim and follow-up reports
* Coordinating findings with our billing specialist
* Assisting with ERA/EFT administrative issues
* Tracking patient responsibility, copays, coinsurance, and deductibles
* Identifying billing or insurance problems before they become aged receivables

## Credentialing and Payer Enrollment Support

Responsibilities may also include:

* Tracking provider credentialing applications
* Following up with payer credentialing departments
* Maintaining provider credentialing documentation
* Tracking licenses and expiration dates
* Assisting with CAQH and payer roster administration
* Supporting Medicaid/OHP and commercial payer enrollment processes

## Back-Office Healthcare Operations

As the role grows, you may also help with:

* Auditing SimplePractice for missing insurance information
* Maintaining authorization and insurance-clearance trackers
* Organizing payer correspondence
* Following up on outstanding administrative tasks
* Creating concise weekly RCM status reports
* Identifying workflow problems
* Helping us document and improve repeatable revenue-cycle processes

## Required Experience

Applicants must have prior experience with **U.S. healthcare insurance or revenue cycle management**.

We strongly prefer candidates with experience in several of the following:

* Insurance eligibility and benefits verification
* Prior authorization
* Medical billing
* Claims follow-up
* Denial management
* Accounts receivable follow-up
* Provider credentialing
* Payer enrollment
* Patient responsibility
* Calling U.S. insurance companies
* Working with payer portals

Experience with **behavioral health, mental health, substance use treatment, outpatient programs, or intensive outpatient programs (IOP)** is highly desirable.

## Strongly Preferred Background

We are particularly interested in candidates who have previously worked with or for:

* UnitedHealthcare / UHC
* Optum
* Blue Cross Blue Shield
* Regence
* Aetna
* Cigna
* Kaiser
* Carelon
* Elevance
* U.S. medical billing companies
* U.S. healthcare revenue-cycle companies
* Healthcare BPOs serving U.S. providers

Experience with any of the following is a plus:

* SimplePractice
* Availity
* CAQH
* Provider portals
* Prior authorization portals
* CPT / HCPCS terminology
* S9480
* H0015
* 90834
* 90837
* 90853

## You Should Already Understand

You should be comfortable with terms such as:

* Eligibility
* Benefits verification
* Deductible
* Copay
* Coinsurance
* Out-of-pocket maximum
* In-network / out-of-network
* Prior authorization
* Authorization dates
* Visit/day limits
* Claims
* Denials
* Accounts receivable
* CPT / HCPCS codes
* Patient responsibility

You will not be expected to independently make clinical decisions or determine coding strategy.

You will be expected to **investigate discrepancies, obtain accurate information from payers, document your findings clearly, and know when an issue should be escalated.**

## What We Are Looking For

You should be:

* Extremely detail-oriented
* Organized
* Persistent
* Reliable
* Comfortable calling U.S. insurance companies
* Fluent and professional in spoken English
* Strong in written English
* Comfortable spending time on hold and following through until an issue is resolved
* Able to document payer conversations accurately
* Comfortable questioning inconsistent information
* Able to distinguish between administrative issues and matters requiring escalation
* Interested in growing into a larger healthcare operations and RCM role

This position involves protected health information. Strict **HIPAA, confidentiality, privacy, and information-security requirements** will apply.

## Technology Requirements

You must have:

* Reliable high-speed internet
* Quiet and private workspace
* Reliable computer
* Headset appropriate for U.S. payer calls
* Backup internet connection
* Reasonable backup plan for power interruptions

## Compensation

**$8–$10 USD/hour to start depending on directly relevant U.S. healthcare experience.**

There will be opportunities for increased hours, responsibility, and compensation as you demonstrate the ability to independently manage these workflows.

## How to Apply

Please do not send a generic application.

Start your application with:

**TRUBRIETY RCM**

Then answer:

1. How many years have you worked with U.S. healthcare insurance or revenue cycle management?
2. Describe your experience performing insurance eligibility and benefits verification.
3. Describe your experience with prior authorization.
4. Describe any claims, denial, or accounts receivable experience.
5. Which U.S. insurance companies have you worked with?
6. Which payer portals have you used?
7. Have you worked in behavioral health, mental health, addiction treatment, or IOP?
8. Which EHR/EMR systems have you used?
9. Have you used SimplePractice?
10. What is your requested hourly rate?
11. What hours are you available in U.S. Pacific Time?
12. What is your primary internet connection and backup internet/power plan?

### Scenario

A behavioral health patient has Regence insurance.

The benefit check shows:

* $1,500 deductible
* Deductible has not been met
* 20% coinsurance after the deductible
* The payer representative says **S9480 is not covered**
* The patient reports that Regence previously authorized IOP treatment at another facility

**Before telling the practice that IOP is not covered, what would you investigate and document?**

Please explain your process.

We are looking for someone who wants a **long-term position and an opportunity to grow with the company**, not someone looking for a temporary freelance project.