Accounts Receivable Lead Medical Billing

Yosemite Pathology (YP) is a private independent pathologist owned and operated surgical pathology and cytology laboratory based in Modesto CA. YP provides comprehensive state of the art reliable and accurate diagnostic services to its physicians and major area hospitals in the Alameda Amador Calaveras Contra Costa Kern Mariposa Merced San Joaquin Solano Stanislaus and Tuolumne counties.

YP offers a full spectrum of tissue pathology cytology and histology services including examination of gynecologic specimens body fluids and fine needle aspiration specimens. We also offer an extensive array of special stains and immunohistochemistry to assist in the management of oncologic and non-oncologic diseases. The laboratory is supported by highly qualified Histotechnologist Cytotechnologist Technicians and office staff who offer excellent service.

Summary/Objective

The Accounts Receivable (AR) Lead plays a critical role in optimizing billing operations and implementing revenue cycle best practices in response to payer adjudication across contracted non-contracted and government payer groups. This position is responsible for overseeing claims processing and accounts receivable activities with a strong focus on resolving low-pay claims denials expected reimbursement discrepancies and appeals.

The AR Lead ensures accurate billing timely reimbursement and compliance with all regulatory and payer requirements while also supporting team performance identifying trends and driving process improvements to enhance overall revenue cycle efficiency.

Shift: Monday Friday 8:00 am 5:00 pm

Essential Functions

• Lead and oversee daily Accounts Receivable (AR) workflows ensuring timely follow-up and resolution of outstanding claims
• Serve as a subject matter expert for pathology billing providing guidance on complex denials coding nuances and payer-specific requirements
• Monitor team productivity and quality metrics; provide coaching feedback and support to ensure KPI targets are met
• Review and prioritize high-value aged and complex AR accounts for resolution
• Identify denial trends and root causes specific to pathology services; develop and implement corrective action plans
• Collaborate with coding front-end and client services teams to resolve billing discrepancies and improve clean claim rates
• Act as a point of escalation for unresolved claims payer issues and client concerns
• Ensure timely filing limits are met and minimize avoidable write-offs
• Audit team work for accuracy compliance and adherence to internal policies and procedures
• Provide training and onboarding support for new team members; assist in developing training materials and standard operating procedures
• Maintain and update payer-specific billing guidelines including pathology-related rules and reimbursement policies
• Partner with management to develop workflow improvements automation opportunities and process efficiencies
• Generate and analyze AR reports including aging denial rates and reimbursement trends; present findings and recommendations to leadership
• Support month-end close processes including reconciliation and reporting activities
• Ensure compliance with all regulatory requirements including HIPAA and payer guidelines

Job Requirements and Skills

• Minimum of 5 years of medical billing experience including strong Accounts Receivable and denial management experience (pathology billing experience strongly preferred)
• Proven experience in a lead or senior-level role with the ability to coach train and support team members
• Advanced knowledge of PPO HMO IPA CMS Managed Medicaid and Managed Medicare plans including payer-specific billing requirements
• Strong working knowledge of CPT and ICD coding with the ability to interpret and apply coding in denial resolution
• Demonstrated expertise in denial management appeals processes and root cause analysis
• Strong understanding of insurance eligibility benefits and front-end impacts on AR outcomes
• Ability to analyze AR aging reports identify trends and implement process improvements
• Experience auditing work for accuracy compliance and quality assurance
• Proficiency in payor portal utilization and navigating multiple systems to resolve claims
• Strong knowledge of timely filing limits and reimbursement guidelines across payers
• Excellent written and verbal communication skills with the ability to effectively interact with patients payers and internal stakeholders
• Strong documentation research and problem-solving skills with attention to detail
• Ability to manage high-volume workloads while maintaining accuracy and meeting deadlines
• Highly organized self-motivated and able to prioritize and reprioritize tasks in a fast-paced environment
• Ability to collaborate effectively across departments and serve as a key resource for issue resolution

Compensation and Benefits:

• The compensation range is $52000 $ 60320 annually (non-exempt) paid semi-monthly on an eight (8) hour per day forty (40) hour per week. Final salary offer subject to multiple factors including candidate experience and expertise geographic location of the role and current market data.
• 401(k) includes an employer match up to 4%
• Robust health plans including dental vision life and mental health support.
• Offer generous annual vacation and sick time
• 10 paid holidays
• Annual scrub allowance for Lab roles

Work Environment & Expectations

• Fast-paced high-volume billing environment
• Regular use of computers billing systems and payor portals
• Frequent communication with internal teams patients and external partners
• Adherence to productivity quality and compliance standards