Claims Follow-Up Lead-CA
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AI Summary
This senior, hands-on role focuses on resolving complex denied and underpaid behavioral health claims, primarily dealing with government payers like Medi-Cal, Medicare, and VA Community Care, while accelerating accounts receivable. The lead will also act as a subject-matter expert to support and elevate the performance of junior follow-up staff in daily workflow execution.
Claims Follow-Up Lead-CA
Department: Finance
Employment Type: Full Time
Location: California (Remote)
Reporting To: Kim
Compensation: $25.00 - $30.00 / hour
Description
Behavioral Health | Government & Commercial Payers | Lean Growth Organization | Remote
WellPsyche Medical Group is a leading telehealth behavioral health organization providing high-quality outpatient mental health services to children, adolescents, and adults across the United States.
As a fully remote organization, our team collaborates to expand access to compassionate mental health care while continuously improving the technology and systems that support patient care.
We are a lean and fast-growing organization, which means every team member plays a meaningful role in improving operations, strengthening revenue cycle performance, and supporting our mission to help patients become the best version of themselves.
Key Responsibilities
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
1. 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.
2. 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.
3. 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
Required Experience
- 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/PHYSICAL REQUIREMENTS:
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
We believe exceptional professionals thrive when they are supported, valued, and given the flexibility to do their best work. That’s why we’ve created a work environment designed to support both your career growth and your personal well-being.
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100% Remote Work – Enjoy the flexibility of working from home while eliminating commute time and costs.
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Technology Support – We provide a company computer along with partial internet reimbursement to ensure you have the tools you need to succeed.
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Comprehensive Health Benefits – Access to competitive health insurance plans designed to support your overall well-being.
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Paid Time Off – We believe rest and personal time are essential for maintaining balance and preventing burnout.
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Work/Life Balance – Our culture prioritizes flexibility, respect, and sustainable workloads.
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Career Growth – As our organization continues to expand, we offer meaningful opportunities for professional development and advancement.
Position Type: Full-Time | 100% Remote
Join a mission-driven organization where your work directly supports access to quality mental health care while helping strengthen and scale a high-performing revenue cycle team.
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