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 necessary

• Oversee productivity and quality program standards as well as payer meetings

• Serve as a subject matter expert for account resolution matters

• Supervise compliance with state and federal regulations in hospitals and clinics, reporting any suspected issues

• Plan, coordinate, and execute onboarding processes for new caregivers

• Organize and deliver staff training and education, including individual sessions, group training, and payer-guideline meetings

• Support leaders in establishing and verifying billing and reimbursement controls

• Mentor caregivers, including staff in Medical Billing Specialist I and II roles

• Analyze and resolve accounts in coordination with revenue cycle departments

• Ensure the accuracy of monthly reconciliation reports

• Bill claims accurately and in compliance with payer filing deadlines

• Collaborate with various revenue cycle and organizational departments to ensure timely billing of claims

• Investigate payer policies, contracts, compliance guidelines, claim errors, and rejections

• Identify trends, root causes, and propose solutions; escalate trends with suggestions

• Work together with payer representatives for compliant claim submissions

• Assist with special projects, audits, and report generation

• Map processes, facilitate improvements, and support departmental change initiatives

• Serve as the project manager for PFS initiatives and ongoing staff training

• Conduct quality reviews and serve as the first escalation point for caregiver issues

• Develop and maintain process and workflow documentation

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

• Maintain both internal and external relationships across PFS, hospitals, clinics, and provider departments

• Perform additional duties as assigned by departmental leaders

⛳️ Requirements

• High School Diploma - Required

• Intermediate to advanced proficiency in Microsoft applications is required

• Exceptional oral and written communication abilities

• Strong organizational and time management skills, with an effective priority-setting capability

• Reliable in terms of both productivity and attendance

• Professional communication skills with internal and external departments and customers

• Creative problem-solving capabilities

• Ability to research and review payer policies, guidelines, and compliance requirements

• Knowledge of medical terminology

• Capacity to appropriately escalate issues to leadership

• Ability to work independently and manage multiple tasks

• Proficient in analyzing and interpreting data

• Ability to organize data and manage time effectively

• Collaborative skills to resolve carrier claims processing challenges

• Ability to continuously operate a computer, telephone, fax machine, calculator, and copier

• Previous leadership experience is highly preferred

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

• Associate's Degree - Preferred

🏝️ Benefits

• Concierge services

• Employee lounge

• Wellness programs

• Free covered parking

• Free on-site and virtual health clinics

• Compensation and recognition programs

• Health care benefits tailored to meet individual employee needs