Medical Billing and Coding

• Perform as proxy for the department manager as needed
• Coordinate productivity and quality program standards and payer meetings
• Serve as a subject matter expert for account resolutions
• Monitor hospital and clinic compliance with state and federal regulations and report suspected issues
• Plan and implement onboarding for new caregivers
• Organize and deliver staff training and education, including individual and group sessions
• Assist leaders in establishing and verifying billing and reimbursement controls
• Mentor Medical Billing Specialist I and II caregivers
• Analyze and resolve accounts with revenue cycle departments
• Complete accurate month-end reconciliation reports
• Compile reports and assist with special projects, audits, and reports
• Accurately and compliantly bill claims
• Meet payer timely filing deadlines
• Collaborate across revenue cycle and organizational areas for accurate, timely claim billing
• Research payer issues, policies, contracts, guidelines, and compliance requirements
• Collaborate with payer representatives on compliant claim submissions
• Analyze complex claim errors and rejections and identify solutions
• Identify trends and root causes and escalate them with solution proposals
• Map processes and facilitate process improvement initiatives
• Design and implement onboarding and ongoing caregiver training
• Perform quality reviews and act as a first escalation tier for caregiver issues
• Create and maintain process and workflow documents
• Attend or lead PFS meetings and coordinate follow-up resolution
• Maintain relationships with PFS departments and provider representatives
• Ensure billers follow correct account-processing steps and procedures
• Perform other duties assigned by departmental leaders

Lead PFS Medical Billing Specialist

• Serve as proxy for the department manager as needed
• Coordinate productivity and quality program standards and payer meetings
• Act as a subject matter expert for account resolutions
• Monitor hospital and clinic compliance with state and federal regulations and report suspected issues
• Plan, coordinate, and implement onboarding for new caregivers
• Organize and implement staff training and education, including one-on-one sessions, group training, and payer-guideline meetings
• Assist leaders in establishing and verifying billing and reimbursement controls
• Mentor caregivers, including Medical Billing Specialist I and II staff
• Analyze and resolve accounts with revenue cycle departments
• Ensure accurate monthly reconciliation reports
• Accurately and compliantly bill claims and meet payer filing deadlines
• Collaborate across revenue cycle and organizational departments for timely claim billing
• Research payer policies, contracts, compliance guidelines, claim errors, and rejections
• Identify trends, root causes, and solutions; escalate trends with proposals
• Collaborate with payer representatives on compliant claim submissions
• Assist with special projects, audits, and reports
• Map processes, facilitate process improvement, and support departmental change initiatives
• Serve as project manager for PFS initiatives and ongoing staff training
• Perform quality reviews and act as a first escalation tier for caregiver issues
• Create and maintain process and workflow documents
• Attend or lead PFS meetings and coordinate follow-up resolution
• Maintain internal and external relationships across PFS, hospital, clinic, and provider departments
• Perform other duties assigned by departmental leaders