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 expertise in professional fee services (PFS) medical billing and supports accurate, compliant, and timely revenue cycle operations.
You will serve as a subject matter expert for complex account resolutions, claim errors, rejections, and payer-related issues.
The position combines hands-on billing responsibilities with mentoring, staff training, quality oversight, and process improvement.
You will collaborate closely with revenue cycle teams, department leaders, caregivers, and payer representatives to resolve issues and strengthen billing practices.
The role also contributes to compliance, reconciliation, reporting, audits, and special projects that support departmental performance.
You will identify recurring issues and root causes, research payer requirements, and recommend practical solutions to improve outcomes.
This is an opportunity for an experienced medical billing professional to take on a leadership-oriented role while remaining closely involved in day-to-day billing operations.

Accountabilities:
- Serve as a proxy for the department manager when needed and provide leadership support for departmental activities.

- Participate in and coordinate productivity and quality program standards as required.

- Participate in and coordinate payer meetings and maintain effective communication with payer representatives.

- Act as a subject matter expert and resource for caregivers in resolving complex billing and account issues.

- Monitor hospital and clinic compliance with applicable state and federal regulations and escalate suspected compliance concerns to department leadership.

- Plan, coordinate, and implement onboarding activities for new caregivers.

- Organize and deliver initial and ongoing staff training, including one-on-one coaching, group sessions, and education on new or updated payer guidelines.

- Assist department leaders in establishing, implementing, and verifying controls that support appropriate billing and reimbursement practices.

- Mentor Medical Billing Specialist I and II employees and other caregivers across the organization.

- Collaborate regularly with revenue cycle departments to analyze and resolve accounts.

- Ensure month-end reconciliation reports are completed accurately and on time.

- Assist department leadership with compiling reports and analyzing billing and revenue cycle information.

- Accurately submit claims while meeting payer-specific requirements and timely filing deadlines.

- Ensure claims are billed in accordance with compliance standards and payer guidelines.

- Collaborate with revenue cycle and other organizational teams to ensure accurate and timely claim submission.

- Stay current on payer policies, billing requirements, and compliance standards and communicate relevant updates to colleagues.

- Identify trends, recurring issues, and root causes affecting billing performance.

- Escalate identified trends with practical solution proposals and recommendations.

- Proactively research payer issues and work with payer representatives to support compliant claim submissions.

- Provide detailed analysis and research into complex claim errors, denials, and rejections.

- Identify and implement appropriate solutions for complex billing issues.

- Support special projects, audits, reporting initiatives, and other departmental priorities.

- Participate actively in team activities, training sessions, and educational meetings.

- Promote a positive, energetic, and collaborative approach across all responsibilities.

Requirements:

- Proven experience in professional fee services medical billing and revenue cycle operations.

- Strong knowledge of medical billing practices, payer requirements, reimbursement processes, and claim submission procedures.

- Dem