Claims Follow-Up Lead-CA

About the role

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.

What we seek from you

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.

What Success Looks Like

• Reduced 90+ day A/R
• Increased appeal overturn rate
• Improved clean claim rate
• Faster payer response cycles
• Clear communication of payer issues

Requirements

• 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

Working conditions

This is a currently a 100% remote role. Must have a home office free from distractions and private for HIPAA purposes, and 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.

Pay

$25.00 - $30.00 / hour

Schedule

Full-Time