Remote - Lead PFS Medical Billing Specialist

The PFS Medical Billing Specialist Lead's general responsibilities include but are not limited to:

• Performs as a proxy for the department manager as needed
• Participates and coordinates productivity and quality program standards as needed
• Participates and coordinates payer meetings as needed
• Performs as a subject matter expert to caregivers for account resolutions
• Ensures and stays up to date on hospital and/or clinic compliance with all state and federal regulations and reports suspected compliance issues to the department manager
• Plans, coordinates, and implements onboarding efforts for new caregivers
• Organizes and implements initial and on-going staff training and education in collaboration with the department leader as needed to drive departmental performance. This includes but is not limited to:
  One-on-One training sessions, group training sessions, and educational meetings for new and updated payer guidelines.
• Assists departmental leaders in establishing, implementing and verifying adherence to controls that maintain appropriate billing and reimbursement practices
• Acts as a mentor to any caregiver within the organization
• Works regularly with all revenue cycle departments to analyze and resolve accounts
• Ensure month-end reconciliation reports are completed accurately each month
• Assists the department manager in compiling reports as needed
• Accurately bill claims
• Ensure timely filing deadlines are met for various payers
• Adequately bill claims per compliance and payer guidelines
• Collaborate with various areas of revenue cycle and the organization to ensure accurate and timely billing of claims
• Stay current on compliance and payer policies and share information with other caregivers within the organization
• Act as a mentor to caregivers in the Medical Billing Specialist I and II roles
• Participates in team activities, trainings and/or educational meetings
• Identifies trends and root causes to issues
• Escalates trends with solution proposals
• Proactively researches and understands payer issues
• Collaborates with payer representatives regarding compliant claim submissions
• Assists with special projects, audits and reports
• Provides extensive analysis and research for complex claim errors and rejections
• Identifies solutions to complex claim errors and rejections
• Projects enthusiasm and energy in all efforts

• Collaborates with manager to map existing processes, facilitates process improvement, assists with identifying and creating approaches to implement change and/or updates and assists with oversight into development plans and execution of plans to improve standards and departmental processes.
• Serves as “project manager” on projects such as PFS initiatives and on-going staff training/education including but not limited to: one-on-one and group caregiver training meetings and educational group meetings.
• Designs, develops, configures, and implements onboarding efforts for new caregivers and ongoing caregiver training/education for existing caregivers.
• Performs as proxy for manager, performs quality reviews for team and acts as a mentor to the Medical Billing Team(s).
• Provides complex review and analysis of claims including researching payer guidelines, collaborating with provider representatives and departmental leaders as necessary in establishing process improvements.
• Creates and maintains process and workflow documents to aid in continuous training for caregivers
• Acts as a first escalation tier for caregiver issues and concerns and will work to resolve/escalate appropriately with manager.
• Knowledgeable in both hospital and professional billing compliance, payor guidelines, and system functionality.
• Research and resolve complex billing questions and discrepancies including familiarity with regulatory…