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.