Patient Accounts Representative Lead

Brief Description The Patient Accounts Representative Lead is a full-time position responsible for assisting the Patient Accounts Supervisor with leading the daily operations. The individual is responsible for managing denials, payments, and accounts receivable (A/R) activity. This role ensures accurate billing, collections, and reconciliation processes while managing denial and appeal activities. The individual is also responsible for auditing financial transactions, identifying overpayments and underpayments, and ensuring compliance with third-party reimbursement guidelines, medical necessity, and coding standards. Additionally, this position provides training, develops workflow improvements, and communicates trends and inconsistencies to key stakeholders.

Essential Duties and Responsibilities:

• Lead and oversee payment posting, denial management, and A/R activities to optimize efficiency and accuracy.

• Coach and coordinate the daily operations of the payment posting and denials team to optimize efficiency, accuracy and timely posting

• Monitor and resolve discrepancies, patterns impacting outstanding balances, and payment activity.

• Audit financial transactions, identify and address overpayments, underpayments, and necessary refunds.

• Research and analyze payer reimbursement guidelines, coding requirements, filing limits, and billing regulations impacting payment and A/R processes.

• Develop and implement training materials and workflow enhancements for the billing staff.

• Recommend updates to claims processes and practice management systems to improve efficiency.

• Review third-party communications and identify potential policy and reimbursement risks; escalate concerns to clinical stakeholders, contract coordinators, and Revenue Cycle leadership.

• Act as the subject matter expert for billing, payment posting, denials and A/R processes.

• Assist with specialized billing and follow-up workflows, including but not limited to:

• Dental Billing

• OB Global Billing

• Out-of-Office Services

• Vision Care

• Behavioral Health

• Specialty Services

Qualifications: Skills:

• Ability to work independently and results-driven.
• Self-starter with a willingness to implement new ideas.
• Strong communication and interpersonal skills.
• Adaptability to frequent changes in duties and workload.
• Excellent problem-solving abilities.
• Ability to collaborate with medical staff to improve clinical and financial outcomes.

Knowledge:

• Healthcare reimbursement processes, third-party payer procedures, and collection techniques.
• Federal, commercial, and state medical reimbursement regulations.
• Medical terminology and coding compliance.

Experience:

• Minimum of 2 years of experience in medical insurance, healthcare billing, and collections within a health system.

Other Elements: Judgment & Initiative:

• Ability to assess and resolve issues, correct errors, and develop processes to improve efficiency.
• Strong initiative with the capability to work independently.

Independent Action:

• Ability to prioritize and manage daily, weekly, monthly, and annual tasks with minimal supervision.

Accountability:

• Ability to meet deadlines and ensure accuracy in financial reporting and audits.

Interrelationships:

• Effective communication with internal and external stakeholders impacting medical billing and patient revenue.
• Collaboration with immediate staff and other managers to resolve problems efficiently.