Remote - Lead PFS Medical Billing Specialist

Mosaic Life Care; El Paso (TX); Remote; USD 60,000 - 100,000; Full time

Benefits offered by this job

Concierge services

Employee lounge

Wellness programs

Free parking

On-site and virtual health clinics

Job summary

Mosaic Life Care is seeking a Medical Billing Specialist Lead to coordinate billing activities, mentor staff, and ensure compliance with payer guidelines. You will leverage strong analytical skills to resolve complex claims and drive process improvements within a hospital and clinic revenue cycle environment.

The role involves collaborating with multiple departments, leading onboarding and ongoing education for caregivers, and ensuring timely submissions and accurate reconciliations.

Qualifications

• Requires knowledge of hospital and professional billing compliance and payer guidelines.
• Strong communication, organization and time management skills.
• Ability to analyze data, escalate issues, and mentor team members.

Responsibilities

• Acts as proxy for the department manager and leads as needed.
• Ensures accurate billing and timely filing deadlines across payers.
• Mentors caregivers in Medical Billing Specialist roles and conducts training sessions.
• Collaborates with revenue cycle and provider departments to resolve issues and improve processes.
• Performs complex reviews of claims, researches payer guidelines, and proposes improvements.
• Produces monthly reports and supports leadership with data for decisions.

Skills

Leadership

Mentoring

Revenue cycle

Payer guidelines

Analytical

Training

Regulatory compliance

Communication

Problem solving

Independence

Education

H.S. Diploma

Associate's Degree

Job description

Remote States: 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

Responsibilities

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 caregiversActs 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 resolutionDevelops 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 preferredPerforms all other duties as assigned by departmental leadersWorks 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

Licenses and Certifications

Qualifications

Skills and Abilities

Essential Technical/Motor SkillsIntermediate to Advanced Microsoft application skills requiredExcellent oral and written communication skillsExcellent organization and time management skills, and ability to establish priorities effectivelyDependable in both production and attendanceCommunicates clearly with professional etiquette with internal and external departments and customersCreative problem-solving skillsResearch and review payer policies, guidelines, and compliance guidelinesMedical Terminology knowledgeEscalate issues appropriately to leadershipAbility to work independently and multi-task as neededInteracts virtually with team to stay connected and informedIntermediate to Advanced Microsoft application skills requiredExcellent oral and written communication skillsExcellent organization and time management skills, and ability to establish priorities effectively

Interpersonal Skills

Communicate effectively in a professional manor to everyone with whom you may interact no matter the diverse background and able to work both independently and as a team to achieve department and organizational goals while promoting a positive group environment.Maintains good rapport and professional relationship with staff.Be a team player.Demonstrates excellent customer service skills by maintaining friendly, courteous and helpful behaviors with everyone.

Essential Physical Requirements

Ability to operate equipment on continuous/repetitious basis such as computer, telephone, fax, calculator, and copier.Job requires sitting mostly, walking and standing occasionally.

Essential Mental Abilities

Ability to analyze and interpret data, explain issues thoroughly, be adaptable in daily responsibilities and flexible based on department and organizational needs, comprehend written and spoken instructions with the ability to retain the information, must be able to organize data and have time management skills and contain the ability to collaborate to resolve any potential carrier claims processing issues

Essential Sensory Requirements

Visually assesses reports and computer screens, hear telephone and have conversations, distinguish computer input screens.Hearing, speaking, and visual skills.

Exposure to Hazards

Limited exposure

Other Skills and Abilities

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.