Lead PFS Medical Billing Specialist

Accountabilities

• Serve as a subject matter expert and first-level escalation resource for complex medical billing questions, account issues, claim errors, rejections, and caregiver concerns.

• Accurately prepare and submit claims while ensuring compliance with payer requirements, applicable regulations, and timely filing deadlines.

• Research payer policies, contracts, guidelines, and complex claim issues, and communicate relevant updates to billing teams and leadership.

• Analyze complex billing discrepancies and account issues, identify root causes, develop solution proposals, and escalate recurring trends appropriately.

• Work closely with revenue cycle departments, provider representatives, departmental leaders, and payer representatives to resolve billing, reimbursement, compliance, and account issues.

• Act as a proxy for the department manager when needed and provide quality reviews, workflow oversight, and mentoring for Medical Billing Specialist I and II team members.

• Coordinate and support productivity and quality programs, payer meetings, PFS initiatives, staff training, educational sessions, and departmental projects.

• Design, develop, and implement onboarding programs for new caregivers as well as ongoing training and education for existing staff.

• Create and maintain process, workflow, and training documentation to support consistent execution and continuous learning.

• Assist departmental leadership in establishing, implementing, and verifying controls that promote accurate billing and appropriate reimbursement practices.

• Ensure month-end reconciliation reports are completed accurately and assist with departmental reporting, audits, special projects, and analysis as needed.

• Collaborate with management to map existing processes, identify improvement opportunities, implement changes, and support development plans designed to improve departmental standards and workflows.

• Attend or lead appropriate PFS meetings, capture follow-up actions, and coordinate with leadership and relevant stakeholders to drive timely resolution.

• Maintain effective internal and external relationships across PFS, hospital, clinic, revenue cycle, and provider teams to support operational initiatives.

• Monitor compliance with state and federal requirements and escalate suspected compliance issues to departmental leadership.

• Promote a dependable, collaborative, and energetic approach to production, attendance, training, problem solving, and team activities.

Requirements:

• Have a high school diploma or equivalent; an associate degree is preferred.

• Bring approximately 4 years of non-clinical healthcare experience, preferably within revenue cycle, medical billing, or patient financial services.

• Demonstrate strong knowledge of hospital and professional billing practices, payer guidelines, reimbursement requirements, and relevant regulatory standards.

• Have substantial experience researching and resolving complex billing questions, claim discrepancies, errors, and rejections.

• Understand payer policies and contracts and be able to translate changes and requirements into practical guidance for billing teams.

• Demonstrate experience with claims processing, timely filing requirements, account resolution, reconciliation, and compliant billing practices.

• Possess strong analytical and problem-solving skills, with the ability to identify trends, determine root causes, and recommend effective solutions.

• Be comfortable working across multiple revenue cycle functions and collaborating with internal departments, provider representatives, payer contacts, and leadership.

• Demonstrate strong communication and mentoring skills, with the ability to train colleagues, facilitate educational sessions, provide constructive guidance, and support onboarding.

• Have the organizational skills required to manage projects, documentation, follow-up actions, training activities, and multiple priorities.

• Demonstrate a high degree of ownership, dependability, attention to detail, and commitment to quality.

• Previous leadership experience is highly preferred, particularly experience mentoring billing teams or coordinating departmental initiatives.

• Be comfortable working within established compliance controls, processes, systems, and healthcare revenue cycle environments.

• Be able to work independently while escalating issues appropriately and maintaining effective communication with managers and cross-functional stakeholders.

• Be available for a full-time Monday-to-Friday schedule with approximately 40 hours per week.

Benefits:

• Fully remote work for candidates residing in eligible states: Alabama, Colorado, Florida, Georgia, Idaho, Indiana, Iowa, Kansas, Kentucky, Minnesota, Missouri, Mississippi, Nebraska, North Carolina, Oklahoma, Texas, Utah, or Virginia.

• Full-time Monday-to-Friday schedule with 40 working hours per week.

• Opportunity to take on a senior, lead-level role within patient financial services and medical billing.

• Leadership and mentoring responsibilities across medical billing teams.

• Exposure to complex healthcare revenue cycle operations, payer relationships, compliance, audits, and process improvement initiatives.

• Opportunities to lead training, onboarding, PFS projects, and continuous improvement efforts.

• Access to a broad employee benefits and wellness offering, including concierge services, wellness programs, employee resources, and health clinic services.

• Opportunity to contribute to healthcare operations focused on accurate, timely, and compliant patient financial services.