Reimbursement Lead

Prince William County Government•Prince William County, VA

1d•Onsite

About The Position

Prince William County Community Services is seeking an experienced, collaborative, results-driven Reimbursement Team Lead to lead its Behavioral Healthcare Reimbursement team. This leadership position supervises reimbursement professionals and coordinates daily medical billing workflows, electronic payment imports into the Electronic Health Record (EHR), claims troubleshooting, and staff mentoring. The role supports accurate, timely, and compliant reimbursement for Outpatient and Community Mental Health Rehabilitative services, helping maintain revenue-cycle integrity and the organization’s financial health. The Reimbursement Team Lead provides day-to-day leadership and oversight of the behavioral health revenue cycle, ensuring efficient billing operations, timely collections, and compliance with federal, state, Medicaid, Medicare, Managed Care Organization (MCO), commercial insurance, and payer requirements. The role collaborates with clinical staff, administrative personnel, managers, fiscal leadership, and external payer representatives, and performs other duties as assigned. The position is based at one of two locations in Woodbridge, Virginia, and may require work at other Community Services sites in Manassas or Woodbridge one or two days per week. The schedule is Monday through Friday, 8:30 AM–5:00 PM, with a one-hour lunch. A valid driver’s license is required. Employment is contingent on passing a DMV record check, TB test, fingerprint-based national criminal history record check, and a Virginia Department of Social Services search of the registry of founded complaints of child abuse and neglect.

Requirements

High school diploma or G.E.D.
Five years of related experience in behavioral healthcare insurance billing, posting, collection, and revenue cycle.
Valid driver’s license.
Pass a DMV record check and TB test.
Pass a fingerprint-based national criminal history record check.
Subject to a Virginia Department of Social Services search of the registry of founded complaints of child abuse and neglect.

Nice To Haves

Experience supervising professional staff managing medical billing, accounts receivable, or healthcare reimbursement.
Knowledge of behavioral healthcare billing, medical coding, revenue cycle, and insurance reimbursement processes.
Knowledge of ICD-10 and CPT coding frameworks.
Knowledge of Virginia Medicaid (DMAS) and Managed Care Organization (MCO) billing requirements.
Experience with Virginia Medicaid (DMAS), MCO, Medicare, and commercial insurance billing requirements.
Experience processing claims in Behavioral Health, Substance Use, or Early Intervention environments.
Hands-on experience with the Credible EHR platform or similar healthcare systems.
Strong understanding of federal and state healthcare reimbursement regulations and compliance standards.
Excellent analytical, problem-solving, organizational, and communication skills.
Proficiency with EHRs, clearinghouses, insurance portals, Microsoft Office applications, and financial reporting tools.
Ability to manage multiple priorities with exceptional attention to detail and provide outstanding customer service to internal and external stakeholders.

Responsibilities

Supervise, mentor, coach, and provide technical guidance to reimbursement professionals; assist the Supervisor with workflow planning and staff training.
Plan, prioritize, and assign staff work to support timely, accurate billing, reimbursement, and account collection activities.
Oversee medical coding, charge entry, claims submission, payment posting, accounts receivable management, denial resolution, and reimbursement activities.
Manage daily electronic payment imports and reconciliation in the EHR, ensuring accurate posting and client account updates.
Coordinate electronic payment workflows, including importing 835s from clearinghouses and insurance portals and distributing payments to staff for posting.
Code electronic and mailed payments daily using the appropriate chart of accounts.
Review unworked claim edits, rejections, and denials; resolve individual claim blocks and compile error details for supervisory review.
Follow up on aged receivables and unpaid services to reduce outstanding balances.
Track the medical authorization process to ensure authorizations are requested and submitted within timely filing windows.
Conduct deposit and transaction audits to maintain accurate internal accounting control records.
Provide operational data and technical assistance to clinical staff, administrative personnel, and managers regarding billing metrics and documentation requirements.
Maintain daily operational compliance with state and federal requirements, HIPAA, and DBHDS regulations.
Monitor clearinghouse activity and insurance payer portals for claim issues, payment variances, and reimbursement opportunities.
Review payment distribution, claims submissions, and reimbursement activities for accuracy, completeness, and timeliness.
Analyze billing transactions, claims, and payment activity to support accurate coding, complete documentation, and timely reimbursement.
Monitor billing matrix errors, denial trends, and unpaid services, collaborating with staff and program leadership to resolve recurring issues.
Compile and analyze statistical and financial data.
Complete monthly financial reconciliations between the EHR.

Benefits

Retirement from the Virginia Retirement System (VRS).
401a and 457 retirement savings and investment plans.
Paid annual leave.
Paid personal leave.
Paid sick leave.
Paid holidays.
Optional group medical and dental health plans.
Optional group life insurance.
Employee Assistance Program (EAP).
Career development opportunities.
Full-time positions with Prince William County Government qualify for Public Service Loan Forgiveness.