Lead PFS Medical Billing Specialist
New
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JobgetherHealthcare billing
Fully remote work for candidates residing in eligible states: Alabama, Colorado, Florida, Georgia, Idaho, Indiana, Iowa, Kansas, Kentucky, Minnesota, Missouri, Mississippi, Nebraska, North Carolina, Oklahoma, Texas, Utah, or Virginia.Full-TimeLead
Salary not disclosed
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Job Details
- Experience
- Approximately 4 years of non-clinical healthcare experience, preferably within revenue cycle, medical billing, or patient financial services.
- Required Skills
- Compliance
Requirements
- Have a high school diploma or equivalent; an associate degree is preferred.
- Bring approximately 4 years of non-clinical healthcare experience, preferably in revenue cycle, medical billing, or patient financial services.
- Demonstrate knowledge of hospital and professional billing practices, payer guidelines, reimbursement requirements, and relevant regulatory standards.
- Have substantial experience researching and resolving complex billing questions, claim discrepancies, errors, and rejections.
- Understand payer policies and contracts and translate changes and requirements into practical guidance for billing teams.
- Have experience with claims processing, timely filing requirements, account resolution, reconciliation, and compliant billing practices.
- Demonstrate analytical and problem-solving skills, including identifying trends, determining root causes, and recommending solutions.
- Be able to collaborate across revenue cycle functions with internal departments, provider representatives, payer contacts, and leadership.
- Have communication and mentoring skills to train colleagues, facilitate educational sessions, provide guidance, and support onboarding.
- Have organizational skills to manage projects, documentation, follow-up actions, training activities, and multiple priorities.
- Demonstrate ownership, dependability, attention to detail, and commitment to quality.
- Previous leadership experience is highly preferred, particularly mentoring billing teams or coordinating departmental initiatives.
- Be available for a full-time Monday-to-Friday schedule of approximately 40 hours per week.
Responsibilities
- Prepare and submit claims accurately in accordance with payer requirements, applicable regulations, and timely filing deadlines.
- Serve as a subject matter expert and first-level escalation resource for complex billing questions, account issues, claim errors, rejections, and caregiver concerns.
- Research payer policies, contracts, guidelines, and complex claim issues, and communicate relevant updates to billing teams and leadership.
- Analyze billing discrepancies and account issues, identify root causes, propose solutions, and escalate recurring trends.
- Collaborate with revenue cycle departments, provider representatives, departmental leaders, and payer representatives to resolve billing, reimbursement, compliance, and account issues.
- Provide quality reviews, workflow oversight, mentoring, and training for Medical Billing Specialist I and II team members.
- Coordinate productivity and quality programs, payer meetings, PFS initiatives, staff training, educational sessions, and departmental projects.
- Develop onboarding programs and maintain process, workflow, and training documentation.
- Complete month-end reconciliation reports and assist with reporting, audits, special projects, and analysis.
- Map processes with management, identify improvement opportunities, implement changes, and support workflow and departmental standards.
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