Lead PFS Medical Billing Specialist

This is a fully remote position, open to applicants in Missouri.

📋 Description

• Act as a representative for the department manager when required.

• Oversee standards for productivity and quality programs as well as payer meetings.

• Function as a subject matter expert for resolving account issues.

• Supervise hospital and clinic adherence to state and federal regulations and report any suspected discrepancies.

• Design and execute onboarding processes for new caregivers.

• Organize and conduct staff training and education sessions, both individually and in groups.

• Support leaders in establishing and validating billing and reimbursement protocols.

• Provide mentorship to Medical Billing Specialist I and II caregivers.

• Analyze and resolve accounts in collaboration with revenue cycle departments.

• Prepare precise month-end reconciliation reports.

• Assemble reports and aid in special projects, audits, and documentation.

• Bill claims accurately and in compliance with regulations.

• Adhere to payer timely filing deadlines.

• Work with different areas in revenue cycle and organizational departments to ensure accurate and timely claim billing.

• Investigate payer issues, policies, contracts, guidelines, and compliance standards.

• Collaborate with payer representatives to ensure compliant claim submissions.

• Examine complex claim errors and rejections, proposing solutions.

• Identify trends and root causes, escalating them with suggested solutions.

• Map processes and facilitate initiatives for process improvement.

• Develop and implement both onboarding and ongoing training for caregivers.

• Conduct quality reviews and serve as the first escalation tier for caregiver-related issues.

• Create and maintain documentation for processes and workflows.

• Participate in or lead PFS meetings and coordinate follow-up resolutions.

• Maintain effective relationships with PFS departments and provider representatives.

• Ensure that billers adhere to correct account-processing protocols and procedures.

• Carry out other duties as assigned by departmental leadership.

⛳️ Requirements

• High School Diploma - Required.

• Intermediate to advanced skills in Microsoft applications are required.

• Exceptional oral and written communication abilities.

• Strong organizational and time management skills, with an aptitude for establishing priorities effectively.

• Reliable in terms of both productivity and attendance.

• Professional communication etiquette with both internal and external departments and clients.

• Innovative problem-solving abilities.

• Capability to research and review payer policies, guidelines, and compliance standards.

• Understanding of medical terminology.

• Ability to escalate issues to leadership when necessary.

• Capacity to work independently and manage multiple tasks.

• Proficiency in analyzing and interpreting data and thoroughly explaining issues.

• Skill in organizing data and managing time efficiently.

• Ability to collaborate effectively to address carrier claims processing challenges.

• Previous leadership experience is highly preferred.

• Associate's Degree - Preferred.

• Four years of non-clinical healthcare experience, preferably in revenue cycle - Preferred.

• Ability to operate computers, telephones, fax machines, calculators, and copiers continuously/repetitively.

• Ability to sit for extended periods, with occasional walking and standing.

• Proficient hearing, speaking, and visual skills.

• Limited exposure to hazards.

🏝️ Benefits

• Concierge services.

• Employee lounge.

• Wellness programs.

• Free covered parking.

• Free on-site and virtual health clinics.

• Compensation and recognition.