Lead PFS Medical Billing Specialist

Accountabilities:

• Serve as a proxy for the department manager when needed and provide leadership support for departmental activities.
• Participate in and coordinate productivity and quality program standards as required.
• Participate in and coordinate payer meetings and maintain effective communication with payer representatives.
• Act as a subject matter expert and resource for caregivers in resolving complex billing and account issues.
• Monitor hospital and clinic compliance with applicable state and federal regulations and escalate suspected compliance concerns to department leadership.
• Plan, coordinate, and implement onboarding activities for new caregivers.
• Organize and deliver initial and ongoing staff training, including one-on-one coaching, group sessions, and education on new or updated payer guidelines.
• Assist department leaders in establishing, implementing, and verifying controls that support appropriate billing and reimbursement practices.
• Mentor Medical Billing Specialist I and II employees and other caregivers across the organization.
• Collaborate regularly with revenue cycle departments to analyze and resolve accounts.
• Ensure month-end reconciliation reports are completed accurately and on time.
• Assist department leadership with compiling reports and analyzing billing and revenue cycle information.
• Accurately submit claims while meeting payer-specific requirements and timely filing deadlines.
• Ensure claims are billed in accordance with compliance standards and payer guidelines.
• Collaborate with revenue cycle and other organizational teams to ensure accurate and timely claim submission.
• Stay current on payer policies, billing requirements, and compliance standards and communicate relevant updates to colleagues.
• Identify trends, recurring issues, and root causes affecting billing performance.
• Escalate identified trends with practical solution proposals and recommendations.
• Proactively research payer issues and work with payer representatives to support compliant claim submissions.
• Provide detailed analysis and research into complex claim errors, denials, and rejections.
• Identify and implement appropriate solutions for complex billing issues.
• Support special projects, audits, reporting initiatives, and other departmental priorities.
• Participate actively in team activities, training sessions, and educational meetings.
• Promote a positive, energetic, and collaborative approach across all responsibilities.

Requirements:

• Proven experience in professional fee services medical billing and revenue cycle operations.
• Strong knowledge of medical billing practices, payer requirements, reimbursement processes, and claim submission procedures.
• Demonstrated ability to analyze and resolve complex claim errors, denials, rejections, and account issues.
• Strong understanding of timely filing requirements and payer-specific billing guidelines.
• Experience interpreting and applying state and federal healthcare compliance requirements.
• Ability to research payer policies, identify root causes, and develop effective solutions to recurring issues.
• Experience collaborating with payer representatives and cross-functional revenue cycle teams.
• Strong analytical and problem-solving skills, with the ability to investigate complex issues and make sound recommendations.
• Demonstrated mentoring, coaching, onboarding, and staff training capabilities.
• Ability to coordinate training programs and communicate changes in payer guidelines or compliance requirements clearly.
• Strong organizational skills and attention to detail, particularly when handling reconciliations, reports, claims, and audits.
• Ability to manage multiple priorities, meet deadlines, and work effectively in a fast-paced revenue cycle environment.
• Strong written and verbal communication skills and the ability to collaborate effectively with caregivers, department leaders, and organizational partners.
• Ability to take initiative, identify opportunities for improvement, and proactively escalate issues with proposed solutions.
• Professional, enthusiastic, and team-oriented approach to work.

Benefits:

• Leadership-oriented opportunity within a medical billing and revenue cycle environment.
• Opportunity to serve as a subject matter expert on complex billing and account resolution.
• Opportunities to mentor, coach, and train medical billing professionals.
• Exposure to payer relations, compliance, audits, reporting, and revenue cycle operations.
• Involvement in process improvement and initiatives designed to strengthen billing accuracy and reimbursement practices.
• Cross-functional collaboration with revenue cycle departments and organizational teams.
• Opportunities to contribute to special projects and departmental performance initiatives.