Lead PFS Medical Billing Specialist

This position is listed on behalf of a partner company, who manages all applications and next steps. Our partner is looking for a Lead PFS Medical Billing Specialist based in United States. This role provides senior-level leadership and subject matter expertise within the patient financial services and medical billing function. You will help ensure accurate, compliant, and timely claim submission while supporting complex account resolution and payer-related issues. The position combines hands-on billing expertise with mentoring, training, quality oversight, process improvement, and cross-functional collaboration. You will serve as a key escalation point for complex billing questions, claim errors, rejections, and compliance concerns. The role also contributes to departmental initiatives, audits, reporting, onboarding, and continuous improvement across revenue cycle operations. It is well suited to an experienced healthcare billing professional who can work independently while helping teams maintain high standards of quality, productivity, and compliance. 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.