Lead PFS Medical Billing Specialist

Accountabilities:: Serve as a proxy for the department manager when needed and provide leadership support for departmental activities. Participate in and coordinate productivity and quality program standards as required. Participate in and coordinate payer meetings and maintain effective communication with payer representatives. Act as a subject matter expert and resource for caregivers in resolving complex billing and account issues. Monitor hospital and clinic compliance with applicable state and federal regulations and escalate suspected compliance concerns to department leadership. Plan, coordinate, and implement onboarding activities for new caregivers. Organize and deliver initial and ongoing staff training, including one-on-one coaching, group sessions, and education on new or updated payer guidelines. Assist department leaders in establishing, implementing, and verifying controls that support appropriate billing and reimbursement practices. Mentor Medical Billing Specialist I and II employees and other caregivers across the organization. Collaborate regularly with revenue cycle departments to analyze and resolve accounts. Ensure month-end reconciliation reports are completed accurately and on time. Assist department leadership with compiling reports and analyzing billing and revenue cycle information. Accurately submit claims while meeting payer-specific requirements and timely filing deadlines. Ensure claims are billed in accordance with compliance standards and payer guidelines. Collaborate with revenue cycle and other organizational teams to ensure accurate and timely claim submission. Stay current on payer policies, billing requirements, and compliance standards and communicate relevant updates to colleagues. Identify trends, recurring issues, and root causes affecting billing performance. Escalate identified trends with practical solution proposals and recommendations. Proactively research payer issues and work with payer representatives to support compliant claim submissions. Provide detailed analysis and research into complex claim errors, denials, and rejections. Identify and implement appropriate solutions for complex billing issues. Support special projects, audits, reporting initiatives, and other departmental priorities. Participate actively in team activities, training sessions, and educational meetings. Promote a positive, energetic, and collaborative approach across all responsibilities. Requirements: Proven experience in professional fee services medical billing and revenue cycle operations. Strong knowledge of medical billing practices, payer requirements, reimbursement processes, and claim submission procedures. Demonstrated ability to analyze and resolve complex claim errors, denials, rejections, and account issues. Strong understanding of timely filing requirements and payer-specific billing guidelines. Experience interpreting and applying state and federal healthcare compliance requirements. Ability to research payer policies, identify root causes, and develop effective solutions to recurring issues. Experience collaborating with payer representatives and cross-functional revenue cycle teams. Strong analytical and problem-solving skills, with the ability to investigate complex issues and make sound recommendations. Demonstrated mentoring, coaching, onboarding, and staff training capabilities. Ability to coordinate training programs and communicate changes in payer guidelines or compliance requirements clearly. Strong organizational skills and attention to detail, particularly when handling reconciliations, reports, claims, and audits. Ability to manage multiple priorities, meet deadlines, and work effectively in a fast-paced revenue cycle environment. Strong written and verbal communication skills and the ability to collaborate effectively with caregivers, department leaders, and organizational partners. Ability to take initiative, identify opportunities for improvement, and proactively escalate issues with proposed solutions. Professional, enthusiastic, and team-oriented approach to work. Benefits: Leadership-oriented opportunity within a medical billing and revenue cycle environment. Opportunity to serve as a subject matter expert on complex billing and account resolution. Opportunities to mentor, coach, and train medical billing professionals. Exposure to payer relations, compliance, audits, reporting, and revenue cycle operations. Involvement in process improvement and initiatives designed to strengthen billing accuracy and reimbursement practices. Cross-functional collaboration with revenue cycle departments and organizational teams. Opportunities to contribute to special projects and departmental performance initiatives.