PFS Specialist Lead

Iberia Medical Center (IMC) in New Iberia, LA is looking for team members to help advance our vision. We've served the community for over 60 years.

The PFS Specialist Lead oversees audits and appeals initiated by PFS Specialists I and II, provides training, creates and maintains edits within the RCM system, tracks claims quantity and quality, develops process manuals, leads monthly Psych Huddle meetings, and supports denial review, research, and resolution. The role also provides back‑up coverage to Commercial, Medicare, Medicaid billers and to the Credit Balance Clerk as needed.

• Oversee audits and appeals initiated by PFS Specialists I and II.
• Train new PFS Specialists I and II.
• Create and maintain edits within the RCM system.
• Lead monthly Psych Huddles.
• Prepare reports as requested by the PFS Assistant Manager or Revenue Cycle Manager.
• Provide backup support to PFS Specialists I and II, including denial review and research guidance.
• Monitor all assigned unpaid accounts—including Commercial, Medicare, Medicare Replacement, Workers’ Compensation, VA, Hospice, and Medicaid—on Monthly ATB reports to ensure timely payment.
• Provide backup coverage for Commercial, Medicare, and Medicaid billers for billing and follow-up as needed.
• Ensure all unresolved issues on Medicare, Medicaid, and Commercial remittance advices are addressed weekly.
• Process, edit, and prepare over 120 Medicaid claims daily; verify successful transmission and receipt by Medicaid.
• Complete initial billing of all claims generated for inpatient and outpatient Behavioral Health services.
• Assist with Contract Management underpayment appeals and related research.

• Education:
  
  High school graduate or equivalent.
• Licensure/Certification: N/A.
• Training and
  
  Experience:
  
  2–3 years of previous hospital business office experience related to filing and collection of insurance claims; thorough knowledge of insurance reimbursement methods.

• Full‑time

• Workers supervised:
  None
• Supervised by: PFS Assistant Manager