Patient Account Services Lead (30379)

GENERAL PURPOSE:

Under the direction of the Patient Account Services (PAS) Supervisor, the Patient Account Services Lead serves as the departments technical expert and workflow coordinator. This position performs advanced billing and accounts receivable functions while providing day-to-day operational guidance, training, quality review, and support to PAS Representatives.

The Lead is responsible for ensuring claims are processed accurately and timely, assisting with workflow prioritization, mentoring staff, identifying process improvements, and serving as the primary resource for complex payer issues.

MAIN RESPONSIBILITIES AND DUTIES:

• Leadership

• Serves as the daily resource and lead support for Patient Account Services Representatives.

• Provides guidance on billing regulations, payer requirements, and best practices.

• Assists with onboarding, training, and coaching of staff.

• Supports the PAS Supervisor by monitoring productivity, coordinating workload distribution, and serving as backup when needed.

• Assists with the planning, implementation, and optimization of new workflows, payer initiatives (e.g., the Program of All-Inclusive Care for the Elderly [PACE]), and system enhancements.

• Revenue Cycle Operations

• Performs all duties of a Patient Account Services Representative.

• Resolves complex billing issues, claim edits, denials, and payer escalations.

• Performs root cause analysis and coordinates resolution of recurring billing and payer trends.

• Reviews aging accounts, monitors timely filing compliance, and supports departmental cash collection goals.

• Assists with PPS reimbursement monitoring, encounter accuracy, reimbursement variance analysis, and ensures accurate coding and documentation prior to billing.

• Serves as a subject matter expert for Medi-Cal Managed Care billing and supports implementation of new payer contracts and PACE revenue workflows.

• Quality Assurance

• Performs quality audits to ensure billing accuracy and compliance with payer regulations.

• Identifies training opportunities and documents recurring errors and trends.

• Assists with reducing denial rates through workflow improvements and quality monitoring.

• Reporting

• Monitors productivity, denial trends, reimbursement variances, and aging reports to identify improvement opportunities.

• Analyzes reporting trends and recommends strategies to improve collections and reduce accounts receivable.

• Assists the PAS Supervisor with departmental metrics and month-end reporting.

• System Support

• Assists with Practice Management system testing, software upgrades, and issue resolution.

• Develops and maintains workflow documentation and standard operating procedures.

• Supports implementation of new workflows, payer requirements, and system enhancements.

• Customer Service

• Resolves escalated patient account and billing concerns.

• Collaborates with clinic leadership and cross-functional departments, including Coding, Credentialing, Finance, IT, and Clinical Operations, to resolve billing issues.

• Other duties as assigned by the PAS Supervisor.

QUALITIES & CHARACTERISTICS

• Maintains a professional relationship and positive attitude with co-workers, the public, patients and all Ampla Health's employee, Board of Directors and vendors.
• Maintains the highest professional ethics and is honest in dealing with people; is a model for all employees through his/her actions.
• Strives to learn more and is receptive to learning different ways of doing things.
• Displays enthusiasm toward the work and the missions of Ampla Health.

PROFESSIONAL KNOWLEDGE, SKILLS & ABLITIES

• High school diploma or equivalent required.
• Associate degree in Business, Healthcare Administration, or a related field preferred.
• Minimum of five years of healthcare billing experience required.
• Minimum of two years of FQHC billing experience preferred.
• Experience with Medicare, Medi-Cal, and Managed Care billing required.
• Experience mentoring or training staff preferred.
• Knowledge of FQHC billing, PPS reimbursement, and encounter-based billing requirements.
• Knowledge of Medicare, Medi-Cal, Managed Care, and payer-specific billing regulations.
• Working knowledge of CPT, ICD-10, and HCPCS coding.
• Strong understanding of denial management, accounts receivable follow-up, and claim resolution.
• Ability to provide leadership, coaching, training, and workflow support in a team environment.
• Strong analytical, problem-solving, and organizational skills.
• Proficiency with Practice Management systems, Microsoft Office, and Excel.

COMMUNICATIONS SKILLS

• Must have neat and legible handwriting
• Must be able to interact with patients courteously and calmly
• Ability to communicate well with the public

WORKING CONDITIONS AND PHYSICAL REQUIREMENTS

Works will with patients in a generally comfortable environment office. Employees must possess the following physical requirements:

• Must be able to hear and communicate with clients and staff on telephone and those who are served "in person", and speak clearly in order to communicate information to clients and staff
• Able to move up to 50 lbs. (small equipments, supplies, etc.)
• Must have vision which is adequate to read memo's, computer screen, registration forms and other clinic documents
• May be exposed to contagious/infectious diseases
• Able to reach above shoulder level to work, must be able to bend, squat and sit, stand, stoop, crouch, reach, kneel, twist/turn
• May be exposed to contagious/infectious diseases

PROFESSIONAL KNOWLEDGE, SKILLS & ABLITIES

• High school diploma or equivalent required.
• Associate degree in Business, Healthcare Administration, or a related field preferred.
• Minimum of five years of healthcare billing experience required.
• Minimum of two years of FQHC billing experience preferred.
• Experience with Medicare, Medi-Cal, and Managed Care billing required.
• Experience mentoring or training staff preferred.
• Knowledge of FQHC billing, PPS reimbursement, and encounter-based billing requirements.
• Knowledge of Medicare, Medi-Cal, Managed Care, and payer-specific billing regulations.
• Working knowledge of CPT, ICD-10, and HCPCS coding.
• Strong understanding of denial management, accounts receivable follow-up, and claim resolution.
• Ability to provide leadership, coaching, training, and workflow support in a team environment.
• Strong analytical, problem-solving, and organizational skills.
• Proficiency with Practice Management systems, Microsoft Office, and Excel.

COMMUNICATIONS SKILLS

• Must have neat and legible handwriting
• Must be able to interact with patients courteously and calmly
• Ability to communicate well with the public