Billing Specialist

Remote - Lead Pfs Medical Billing Specialist

Candidates residing in the following states will be considered for remote employment: Alabama, Colorado, Florida, Georgia, Idaho, Indiana, Iowa, Kansas, Kentucky, Minnesota, Missouri, Mississippi, Nebraska, North Carolina, Oklahoma, Texas, Utah, and Virginia. Remote work will not be permitted from any other state at this time.

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

About Us

Mosaic Life Care is a health care system in northwest Missouri. With a vision of transforming community health by being a life-care innovator, Mosaic places the holistic needs of patients first by providing the right care at the right time and place, offering high value and quality health care. Mosaic has a wide array of benefits to meet each employee's individual needs. Our benefits were designed by listening to people just like you. Mosaic also offers several perks with a focus on ensuring our employees feel valued, including concierge services, employee lounge, wellness programs, free covered parking, free on-site and virtual health clinics and many more. When paired with compensation and recognition, it is what continues to make us the employer of choice for employees at any stage of their journey.