Lead, Patient Financial Services Billing And Follow-up
At NorthBay Health, the Lead, Patient Financial Services Billing and Follow-up provides advanced operational oversight and subject matter expertise supporting Supervisors and staff responsible for billing, follow-up, and collections of hospital patient accounts.
This role serves as a senior escalation resource and workflow leader, ensuring timely, accurate billing and follow-up activities across all major payer groups, including Medi-Cal, Medicare, and Commercial payers. The Lead is responsible for helping with daily performance, resolving complex accounts, ensuring regulatory compliance, and supporting revenue cycle outcomes including cash collections, denial prevention, and A/R reduction.
Acts as a liaison between frontline staff, Supervisors, and leadership to optimize workflows, standardize processes, and improve overall team performance.
PRIMARY JOB DUTIES
- Provide day-to-day operational leadership and support to supervisors and staff across billing and A/R follow-up functions.
- Serve as the primary subject matter expert (SME) for Medi-Cal, Medicare, and Commercial payer billing and follow-up, including payer-specific rules, reimbursement methodologies, and escalation pathways.
- Review and resolve complex or high-dollar accounts, including denials, underpayments, and aged A/R across all payer types.
- Monitor work queues and ensure timely billing, follow-up, and account resolution in alignment with departmental KPIs and regulatory requirements.
- Partner with supervisors to drive staff productivity, quality, and accountability for A/R performance, cash collections, and denial resolution.
- Analyze payer trends (Medi-Cal, Medicare, Commercial) to identify root causes of denials, delays, and underpayments; recommend and implement corrective actions.
- Ensure compliance with all federal and state regulations, including CMS guidelines, Medi-Cal requirements, and payer contract terms.
- Provide advanced training, education, and real-time coaching to staff and supervisors on billing processes, payer requirements, and system workflows.
- Assist supervisors with auditing staff performance, accounting quality, and documentation standards.
- Support the development and standardization of workflows, policies, and procedures related to billing and A/R follow-up.
- Collaborate with internal departments (coding, HIM, case management, customer service) and external stakeholders (payers, vendors) to resolve issues and improve revenue cycle performance.
- Function as escalation point for payer issues requiring advanced research, including appeals, reconsiderations, and payment discrepancies.
- Assist leadership in preparing reports, dashboards, and performance summaries related to A/R, denials, and cash collections.
- Support system optimization efforts (Epic, clearinghouses, payer portals) to improve efficiency and automation.
- Lead or participate in special projects focused on revenue cycle improvement, denial reduction, and cash acceleration.
Qualifications
Education: Associate's degree preferred or equivalent combination of education and/or 4 years of relevant experience.
Licensure / Certification: All new hires will be required to complete the HFMA Certified Revenue Cycle Representative (CRCR) training course within the first nine (9) months of employment. The employer will sponsor membership, training, and certification costs.
Experience
- Minimum 5–7 years of experience in hospital or professional billing and A/R follow-up
- Advanced experience with Medi-Cal, Medicare, and Commercial payer processes
- Prior Lead or senior-level experience preferred.
- Strong background in denials management, appeals, and payer resolution
- Experience with revenue cycle systems (e.g., Epic Resolute preferred)
Skills & Competencies
- Excellent oral and written communication skills.
- Proficient in PC applications and Microsoft Office Suite, specifically Excel.
- Strong analytical skills with exceptional attention to detail.
- Skilled in training and providing education to staff.
- Strong organizational skills and ability to prioritize tasks effectively.
Interpersonal Skills
- Demonstrates the True North values. True North values are a set of value-based behaviors that are to be consistently demonstrated, and role modeled by all employees that work at NorthBay Health.
- The True North values principles consist of Nurture/Care, Own It, Respect Relationships, Build Trust, and Hardwire Excellence.
- Ability to prioritize tasks and communicate delays effectively.
- Strong interpersonal communication skills across all organizational levels.
- Ability to supervise a team with professionalism, inclusion, and effective communication.
Standards of Performance: Demonstrate performance by adhering to established policies and procedures and exhibiting the defined characteristics associated with attendance and punctuality.
Physical Effort: Attendance is an essential function of the job. The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodation may be made to enable individuals with disabilities to perform the essential functions.