BILLING TEAM LEAD
Job Summary
We are seeking a highly skilled and detail-oriented Billing Team Lead to coordinate the billing and reimbursement processes for insurance claims. While remaining a hands-on participant in daily billing operations, the Team Lead serves as a Subject Matter Expert (SME) to provide technical direction and peer coaching to the billing staff.
Key Responsibilities
Workflow Oversight: Monitor team work-queues and assign daily tasks to ensure claims are submitted within deadlines and in accordance with payer guidelines.
Peer Coaching: Provide side-by-side coaching and technical guidance to team members on complex billing issues, new coding updates, and payer policy changes.
Quality Review & Direction: Review peer work for accuracy (pre-submission) and provide constructive technical feedback to ensure compliance with company policies.
Escalation Point: Act as the first point of contact for team members to resolve "stuck" claims, complex medical necessity denials, or difficult payer discrepancies.
Trend Analysis: Generate and analyze billing reports to identify team-wide denial trends; lead informal "huddles" to discuss solutions and process improvements.
Audit Coordination: Lead the team’s response to insurance payer inquiries, documentation requests, and formal audits.
Direct Billing & Claims Execution
Claim Submission: Process and submit medical claims to insurance carriers (Aetna, Cigna, Blue Cross, United Healthcare, Medicare, Medicaid, Workers' Comp).
Verification: Review patient records and coding (ICD-10, CPT, HCPCS) to verify accuracy before submission.
Denial Management: Follow up on unpaid, denied, or rejected claims; work directly with insurance representatives and providers to resolve discrepancies and resubmit.
Remittance Review: Analyze remittance advice (EOB) to identify underpayments, misapplied adjustments, or issues requiring high-level appeals.
Payer Communication: Maintain professional communication with insurance representatives to clarify policy details, coverage, and specific billing issues.
Support Patient Advocacy: Support team members in explaining insurance coverage, payment responsibilities, and complex billing processes to patients.
Record Maintenance: Ensure the team maintains detailed, accurate records of all claims, payments, and adjustments within the billing/EMR system.
Compliance: Stay current with insurance regulations and coding updates to ensure the entire team remains compliant with federal and state laws.
Requirements
Experience: 3–5 years of advanced experience in medical billing and claims denial resolution.
Leadership Ability: Proven ability to provide direction, coaching, and technical support to peers in a collaborative environment.
Technical Expertise: Advanced proficiency in medical coding (ICD-10, CPT, HCPCS) and deep familiarity with CMS (Medicare/Medicaid) and commercial payer portals.
Analytical Skills: Strong ability to identify billing errors and analyze reports to improve "clean claim" rates for the team.
Communication: Excellent verbal and written skills for drafting formal appeals and communicating complex details to providers and patients.
Organization: Expert time-management skills with the ability to manage personal claim volume while simultaneously coordinating team priorities.
Systems: High proficiency in electronic medical record (EMR) systems (e.g., Epic, Cerner) and clearinghouse software.
Preferred Qualifications
Certification: Certification through AAPC (Certified Professional Biller) or AHIMA (Certified Coding Specialist).
Contract Knowledge: Familiarity with specific insurance payer contracts, stop-loss provisions, and reimbursement structures.
Prior Lead Experience: Previous experience in a "Lead," "SME," or similar role within a Union or work-team environment.