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 on boarding 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 guidelines.
• Proactively researches and understands payer policies and contracts and accurately provides updated information to the PFS teams and Leadership.
• Collaborates with other departments within revenue cycle to resolve billing and compliance issues or concerns.
• Attend and/or lead appropriate PFS meetings to capture follow-up items and coordinates with appropriate leadership for resolution
• Develops and maintains continuity with internal and external relationships for multiple PFS and hospital/clinic departments/provider representatives to ensure support and participation in PFS initiatives.
• Previous leadership experience highly preferred
• Performs all other duties as assigned by departmental leaders
• Works regularly with other revenue cycle departments to analyze and resolve accounts and/or systematic issues.
• Works with revenue cycle leadership to ensure that billers are following the correct steps and processes when working accounts.
• Dependable in both production and attendance

Education

• H.S. Diploma - Required
• Associate's Degree - Preferred

Work Experience

• 4 Years - Non-clinical healthcare experience, preferably in revenue cycle - Preferred

Licenses and Certifications

Skills and Abilities

Essential Technical/Motor Skills

• Intermediate to Advanced Microsoft application skills required
• Excellent oral and written communication skills
• Excellent organization and time management skills, and ability to establish priorities effectively
• Dependable in both production and attendance
• Communicates clearly with professional etiquette with internal and external departments and customers
• Creative problem-solving skills
• Research and review payer policies, guidelines, and compliance guidelines
• Medical Terminology knowledge
• Escalate issues appropriately to leadership
• Ability to work independently and multi-task as needed
• Interacts virtually with team to stay connected and informed
• Intermediate to Advanced Microsoft application skills required
• Excellent oral and written communication skills

• Excellent organization and time management skills, and ability to establish priorities effectively

Interpersonal Skills

• Communicate effectively in a professional manor to everyone with whom you may interact no matter the diverse background and able to work both independently and as a team to achieve department and organizational goals while promoting a positive group environment.
• Maintains good rapport and professional relationship with staff.
• Be a team player.
• Demonstrates excellent customer service skills by maintaining friendly, courteous and helpful behaviors with everyone.

Essential Physical Requirements

• Ability to operate equipment on continuous/repetitious basis such as computer, telephone, fax, calculator, and copier.
• Job requires sitting mostly, walking and standing occasionally.

Essential Mental Abilities

• Ability to analyze and interpret data, explain issues thoroughly, be adaptable in daily responsibilities and flexible based on department and organizational needs, comprehend written and spoken instructions with the ability to retain the information, must be able to organize data and have time management skills and contain the ability to collaborate to resolve any potential carrier claims processing issues

Essential Sensory Requirements

• Visually assesses reports and computer screens, hear telephone and have conversations, distinguish computer input screens.
• Hearing, speaking, and visual skills.

Exposure to Hazards

• Limited exposure

Other Skills and Abilities