Pre-Service RCM Specialist (Prior Authorization / Insurance Verification)

Join a team that puts people at the center of everything.

At TLNT, we believe that recruitment is more than just filling roles — it’s about connecting humans with humans. We’re a people-first organization partnering with top U.S. companies to help them grow by attracting exceptional talent, and we know that the right content can open the right doors.

This is an excellent opportunity to grow your career with a leading US-based company — fully remote, on a small team where you work directly with the CEO and your work is visible from day one.

You’ll work with a U.S. revenue cycle company focused on complex, high-value surgical care. They help surgical practices verify insurance benefits, secure prior authorizations, submit clean claims, and get paid accurately for their work. It’s a small, modern, remote-first team where your growth path is real.

In this role, you own everything that happens before a patient’s surgery: verifying benefits by phone and portal, chasing clinical records from surgeon offices, preparing and submitting prior authorization requests, working appeals, and flagging surgery-date risk early — before it becomes an emergency. This job is for someone relentless: you call again, you follow up again, and you never let a case sit. It’s also thinking work — you read payer medical policies and plan documents, compare them against the clinical record, and know whether a request is strong, weak, or missing something before it goes out.

What You'll Do

- Run verification of benefits (VOB) and eligibility checks for surgical cases, including out-of-network benefit details,



authorization requirements, and pre-surgery re-verification.
- Handle carrier phone work: authorization status, expedites, and peer-to-peer scheduling — with every call documented the same day (reference number, representative name, outcome, next action).
- Follow up on clinical records with U.S. surgeon offices — persistent and professional — escalating anything that threatens a surgery date.
- Prepare and submit prior authorizations: assemble clinical documents, submit by portal or fax, track decisions, and stay on top of every pending request until it is answered.
- Review payer medical necessity criteria, medical policies, and plan documents against the clinical records on file, and flag gaps before submission — not after a denial.
- Write and follow through on authorization appeals for your cases, all the way to a decision.
- Keep the case platform current at all times: statuses, tasks, call logs, and documents.

What You Bring

- Naturally relentless. You follow up without being asked, you don’t accept the first no, and you keep going until the case is resolved. We want people we never have to push.
- Sharp and analytical. You can read a medical policy, a plan document, or a clinical note, pull out what matters, and form a real judgment. This is thinking work,



not data entry.
- Fluent with AI tools. You use them every day to read faster, draft better, and check your own work — and you know when not to trust them.
- 2 to 4+ years in U.S. healthcare revenue cycle on the front end (insurance verification, eligibility, prior authorization, referrals), working with U.S. payers directly.
- Professional English, spoken and written (C1 or better). You’ll speak with U.S. payer representatives and surgeon-office staff every day.
- Payer portal fluency (Availity and major carrier portals) and real phone stamina — long hold queues are part of the work.
- Meticulous documentation habits, a quiet home office, and reliable high-speed internet.
- Willingness to sign confidentiality and HIPAA agreements, complete compliance training, and pass a background check.

Nice to have

- Surgical specialty experience.
- Medical terminology or coding coursework.
- Experience at a U.S.-facing revenue cycle company.

Salary & Perks

- Competitive Pay in USD, paid monthly.
- This is a full-time, long-term engagement with room to grow — and direct access to the CEO.
- Target start date: September 2026.
- The position is immediately available and requires entering into an independent contractor agreement.
- 100% remote — open to LATAM, with Mexico strongly preferred (Monterrey, Guadalajara, CDMX).
- Monday through Friday, 7:00 a.m. to 5:00 p.m. US Central Time.

Ready to apply?

We’d love to hear your story. The next step is a short application where you can share more about your background and upload your resume in English.

📌 Pre-Service RCM Specialist (Prior Authorization / Insurance Verification) (México)
🏢 TLNT Group
📍 México