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. We've 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 office experience related to the filing and collection of insurance claims.  Must have thorough knowledge of insurance reimbursement methods.

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 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.