Iberia Medical Center · 1 month ago
PFS Specialist Lead
New Iberia, LA
Full-time
Onsite
Entry, Mid Level
2+ years expIberia Medical Center (IMC) is looking for a PFS Specialist Lead to oversee audits and appeals initiated by PFS Specialists I and II while providing training for new employees. This role involves maintaining edits within the RCM system, tracking claims, and assisting with various billing processes for different insurance types.
Health CareHospitalMedical
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 accounts—including Commercial, Medicare, Medicare Replacement, Workers’ Compensation, VA, Hospice, and Medicaid—on 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
Qualification
Required
High school graduate or equivalent
2-3 years previous hospital business office experience related to the filing and collection of insurance claims
Must have thorough knowledge of insurance reimbursement methods
Company
Iberia Medical Center
Iberia Medical Center is a non-profit community that is expertise in improvising the health and life of several patients across the globe.
501-1000 employees
Funding
Current Stage
Late StageLeadership Team
Sandy Morein, RN, BSN, MHA, CPPS, FACHE
Vice President / Chief Nursing Officer
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