Reimbursement Lead

Prince William County; Virginia; On-site; USD 71,000 - 98,000; Full time

Benefits offered by this job

Retirement from the Virginia Pension

401a and 457 retirement plans

Paid annual leave

Paid personal leave

Paid sick leave

Paid holidays

Medical and dental options

Life insurance

Employee Assistance Program (EAP)

Career development opportunities

Job summary

Prince William County Community Services seeks an experienced Reimbursement Team Lead to guide our Behavioral Healthcare Reimbursement team. This leadership role oversees professional reimbursements, daily billing workflows, and EHR payment imports, ensuring accurate, timely, and compliant revenue cycle operations.

The successful candidate will mentor staff, manage claims submissions, analyze denials, and monitor regulatory requirements across Medicaid, Medicare, DMAS, MCOs, and commercial

Qualifications

• Minimum 5 years of related experience in behavioral healthcare insurance billing, posting, collection, and revenue cycle.
• Knowledge of Medicaid/DMAS, Medicare, and payer requirements.
• Ability to supervise staff and manage workflow priorities.

Responsibilities

• Supervise, mentor, coach, and provide guidance to reimbursement professionals.
• Plan, prioritize, and assign work to ensure timely, accurate billing and collections.
• Oversee billing operations including coding, claims submission, payment posting, and AR management.
• Monitor clearinghouses and payer portals for issues and opportunities.
• Provide operational data and support to clinical staff and managers regarding billing metrics.

Skills

Leadership

Billing & reimbursement

Staff mentorship

Regulatory compliance

Education

High school diploma or GED

Tools

Credible EHR

Job description

Introduction

Prince William County Community Services (CS) is seeking an experienced, collaborative, results-driven Reimbursement Team Lead to lead our Behavioral Healthcare Reimbursement team. We are a large, community-based behavioral health organization dedicated to providing high-quality services while ensuring accurate, timely, and compliant reimbursement for the care we provide.

This leadership position supervises reimbursement of professionals and will coordinate daily medical billing workflows, handle electronic payment imports into the Electronic Health Record (EHR), troubleshoot claims errors, and mentor staff to maximize revenue collection for Outpatient and Community Mental Health Rehabilitative services. The position plays a critical role in ensuring the integrity of the revenue cycle, maximizing reimbursement, maintaining regulatory compliance, and supporting the financial health of the organization.

About The Role

The Reimbursement Team Lead provides day-to-day leadership and oversight of the behavioral health revenue cycle, ensuring efficient billing operations, timely collections, and compliance with all federal, state, Medicaid, Medicare, Managed Care Organization (MCO), commercial insurance, and payer requirements.

Key Responsibilities Include

• Supervise, mentor, coach, and provide technical guidance to a team of reimbursement professionals, assisting the Supervisor with workflow planning and staff training.
• Plan, prioritize, and assign staff work to ensure timely, accurate billing, reimbursement, and account collection activities.
• Oversee billing operations, including medical coding, charge entry, claims submission, payment posting, accounts receivable management, denial resolution, and reimbursement activities.
• Manage the daily import and reconciliation of electronic payments into the EHR, ensuring accurate posting and client account updates.
• Coordinate daily electronic payment workflows, including imports of 835s from clearinghouses and insurance portals, and direct electronic distribution for staff posting.
• Perform daily coding of electronic and mailed payments using the appropriate chart of accounts.
• Review unworked claim edits, rejections, and denials to resolve individual claim blocks and compile error details for supervisory review.
• Execute timely follow-up on aged receivables and unpaid services to reduce outstanding balances.
• Track the medical authorization process to ensure authorizations are requested and submitted within strict timely filing windows.
• Conduct deposit and transaction audits to maintain accurate internal accounting control records.
• Provide operational data and technical assistance to clinical staff, administrative personnel, and managers regarding billing metrics and documentation requirements.
• Ensure daily operations maintain strict compliance with state, federal, HIPAA, and DBHDS regulations.
• Monitor clearinghouse activity and insurance payer portals to identify claim issues, payment variances, and reimbursement opportunities.
• Review electronic payment distribution, claims submissions, and reimbursement activities to ensure accuracy, completeness, and timeliness.
• Analyze billing transactions, claims, and payment activity to ensure accurate coding, complete documentation, and timely reimbursement.
• Monitor billing matrix errors, denial trends, and unpaid services while collaborating with staff and program leadership to resolve recurring issues.
• Compile and analyze statistical and financial data.
• Complete monthly financial reconciliations between the EHR.
• Perform other duties as assigned.

The Successful Candidate Will Have

The ideal candidate is an experienced healthcare revenue cycle leader with strong knowledge of behavioral healthcare billing, Medicaid reimbursement, insurance claims management, and regulatory compliance. They possess exceptional analytical, organizational, and leadership skills and can build collaborative relationships with clinical staff, fiscal leadership, and external payer representatives.

Minimum Requirements

High school diploma or G.E.D. and 5 years of related experience in behavioral healthcare insurance billing, posting, collection, and revenue cycle.

Preferences

• Experience supervising professional staff managing medical billing, accounts receivable, or healthcare reimbursement staff.
• Knowledge of behavioral healthcare billing, medical coding, revenue cycle, and insurance reimbursement processes.
• Knowledge of ICD-10 and CPT coding frameworks.
• Knowledge of Virginia Medicaid (DMAS) and Managed Care Organization (MCO) billing requirements.
• Experience working with Virginia Medicaid (DMAS), Managed Care Organizations (MCOs), Medicare, and commercial insurance billing requirements.
• Experience processing claims specifically for Behavioral Health, Substance Use, or Early Intervention environments.
• Hands-on experience using the Credible Electronic Health Record (EHR) platform or similar healthcare systems.
• Strong understanding of federal and state healthcare reimbursement regulations and compliance standards.
• Excellent analytical, problem-solving, organizational, and communication skills.
• Proficiency with Electronic Health Records (EHRs), clearinghouses, insurance portals, Microsoft Office applications, and financial reporting tools.
• The ability to manage multiple priorities while maintaining exceptional attention to detail and delivering outstanding customer service to both internal and external stakeholders.

Special Requirements (if Applicable)

• Must possess a valid driver’s license.
• Must pass DMV record check.
• Must pass TB test.
• Offer of employment is contingent upon the candidate passing a fingerprint-based national criminal history record check.

Child Protective Services Requirements: Effective 1999, mandated by the Virginia Department of Behavioral Health and Developmental Services (DBHDS) in accordance with 12VA35-105-400 rules and regulations for DBHDS Licensed Providers and related to the Criminal Registry Checks, a search of the registry of founded complaints of child abuse and neglect will be conducted by the Virginia Department of Social Services.

Work Schedule

The work hours will be Monday through Friday, 8:30 AM – 5:00 PM with a one-hour lunch. The position will be based out of one of two locations in Woodbridge, Virginia, and may be required to work one or two days a week at other Community Services work sites in Manassas or Woodbridge.

Hiring Salary Range

$70,921.50 - $97,968.00 Annually

We Also Offer Great Benefits, Including

• Retirement from the Virginia Retirement System (VRS)
• 401a and 457 retirement savings and investment plans
• Paid Annual Leave
• Paid Personal Leave
• Paid Sick Leave
• Paid Holidays
• Optional Group Medical and Dental Health Plans
• Optional Group Life Insurance
• An Employee Assistance Program (EAP)
• Career Development Opportunities

Full-time positions with Prince William County Government qualify for Public Service Loan Forgiveness.

NOTE:

The above position description is intended to represent only the key areas of responsibilities; specific position assignments will vary depending on the business needs of the department.

Prince William County is an Equal Opportunity Employer. In compliance with the Americans with Disabilities Act, the County will provide reasonable accommodations to qualified individuals with disabilities and encourages both prospective and current employees to discuss potential accommodations with the employer.

SEE YOURSELF HERE!

Prince William County Government offers medical plans with corresponding pharmacy and basic vision coverage, as well as dental plans and a separate vision plan.

Full-time and part-time Prince William County Government employees are eligible to participate in our plans; however, the level and cost of benefits depends on the classification of the position.

The following positions do not accrue leave and are not eligible for holidays or other fringe benefits

• Temporary
• Provisional
• Seasonal employees