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Role Description

The Claims Follow-Up Lead is a senior, hands-on revenue cycle professional responsible for resolving complex denials, accelerating accounts receivable, and supporting daily claims workflow execution. This is a working lead role — not a full people management position — designed for someone who can both execute independently and elevate the performance of the follow-up team. The ideal candidate is experienced in behavioral health billing, government payers, and high-volume claims follow-up, and thrives in a fast-moving, accountability-driven environment.

• High-Complexity Claims Resolution (Primary Function)
  • Follow up on denied, underpaid, and aged behavioral health claims.
  • Work complex government payers including:
    • Medi-Cal / Medicaid (FFS & Managed Care)
    • Medicare (Part B & Advantage)
    • VA Community Care (TriWest / Optum)
  • Submit appeals and corrected claims within timely filing limits.
  • Escalate payer issues strategically and track resolution outcomes.
• A/R Performance Impact
  • Prioritize high-value and aging accounts.
  • Identify denial trends and root causes.
  • Proactively surface systemic billing issues to leadership.
  • Contribute directly to cash flow improvement.
• Workflow Leadership
  • Act as subject-matter expert for junior follow-up staff.
  • Assist with daily work allocation and prioritization.
  • Support productivity and quality standards.
  • Participate in process improvements in a fast-moving environment.
  • Possess qualities supporting the company values of people matter, compassionate leadership, mamba mentality, WOW service.

Qualifications

• 3–5+ years behavioral health claims follow-up
• Strong government payer experience
• Experience in high-volume, multi-state billing
• Ability to work independently in a remote setting
• Comfortable in a startup environment with evolving processes

Requirements

• This is a currently a 100% remote role.
• Must have a home office free from distractions and private for HIPAA purposes.
• Be available during work hours via Zoom, Chat, phone and other communication methods.

Benefits

• 100% Remote Work – Enjoy the flexibility of working from home while eliminating commute time and costs.
• Technology Support – We provide a company computer along with partial internet reimbursement to ensure you have the tools you need to succeed.
• Comprehensive Health Benefits – Access to competitive health insurance plans designed to support your overall well-being.
• Paid Time Off – We believe rest and personal time are essential for maintaining balance and preventing burnout.
• Work/Life Balance – Our culture prioritizes flexibility, respect, and sustainable workloads.
• Career Growth – As our organization continues to expand, we offer meaningful opportunities for professional development and advancement.