Lead, Account Representative (4597)

Position Summary:

The Lead, Account Representative is an advanced-level billing and reimbursement specialist responsible for managing complex medical claims, resolving escalated account issues, and ensuring full compliance with payer regulations. This role handles high-difficulty accounts that require in-depth investigation, advanced follow-up strategies, and a strong working knowledge of payer rules and reimbursement requirements. Working collaboratively with clinical and administrative departments, the Lead, Account Representative supports process improvements, provides insight on complex billing challenges, and promotes consistent documentation standards. This position plays a critical role in maintaining the integrity and efficiency of the revenue cycle while contributing to a knowledgeable, collaborative team environment focused on accuracy, accountability, and continuous improvement.

Key Responsibilities:

• Process, audit, and submit complex or high value medical claims with strict adherence to payer regulations and organizational standards.
• Conduct detailed follow up on outstanding or denied claims, performing advanced troubleshooting and coordinating corrections to secure timely reimbursement.
• Serve as a subject matter resource for billing policies, escalating payer rule changes and assisting with internal workflow adjustments.
• Collaborate with clinical departments, coding teams, and registration staff to resolve discrepancies affecting claim accuracy or payment. Maintain comprehensive documentation of all billing actions, payer interactions, and claim adjustments to ensure accuracy and traceability.
• Assist leadership with training, quality assurance reviews, and process enhancements to improve billing efficiency and compliance across the department.