PFS Specialist Lead

Iberia Medical Center (IMC) in New Iberia LA is looking for team members who will help advance our vision to be the premier hospital of choice for patients physicians and employees. Weve been caring for our community for over 60 years and offer many diverse career paths. Our new employees experience opportunities to learn and grow while caring for their families friends and neighbors.

IMC is currently looking for a PFS Specialist Lead role oversees all audits and appeals initiated by PFS Specialists I and II and provides training for all new employees. It includes creating and maintaining edits within the RCM system and tracking claims worked by each biller to ensure productivity and quality. The position assists with the development and upkeep of departmental process manuals and leads the monthly Psych Huddle meetings. It also serves as backup to PFS Specialists I and II by supporting denial review research and resolution efforts. Responsibilities include resolving unpaid claims for Commercial Insurance Medicare Medicare Replacement Workers Compensation Hospice VA and Medicaid as assigned by the PFS Supervisor. Additionally the role provides back-up coverage to the Commercial Medicare and Medicaid billers for billing and follow-up as well as support to the Credit Balance Clerk as needed.

SCHEDULE

• Full-Time

JOB RELATIONSHIP

• WORKERS SUPERVISED: None
• SUPERVISED BY: PFS Assistant Manager

QUALIFICATIONS:

• Education:High school graduate or equivalent.
• Licensure/Certification: N/A.
• Training and Experience: 2-3 years previous hospital business officeexperience related to the filing and collection of insurance claims. Must have thorough knowledge of insurance reimbursementmethods.

PRINCIPLE TASKS DUTIES AND RESPONSIBILITIES

• Oversees and assists with audits and appeals initiated by PFS Specialists I and II.

• Trains all new PFS Specialists I and II.

• Creates and maintains edits within the RCM system.

• Leads monthly Psych Huddles.

• Prepares reports as requested by the PFS Assistant Manager or Revenue Cycle Manager.

• Provides backup support to PFS Specialists I and II including denial review and research guidance.

• Monitors all assigned unpaid accountsincluding Commercial Medicare Medicare Replacement Workers Compensation VA Hospice and Medicaidon Monthly ATB reports to ensure timely payment.

• Provides backup coverage for Commercial Medicare and Medicaid billers for billing and follow-up as needed.

• Ensures all unresolved issues on Medicare Medicaid and Commercial remittance advices are addressed weekly.

• Processes edits and prepares over 120 Medicaid claims daily; verifies successful transmission and receipt by Medicaid.

• Completes initial billing of all claims generated for inpatient and outpatient Behavioral Health services.

• Assists with Contract Management underpayment appeals and related research.