Lead Billing Specialist, Full Time

About the role

A Lead Billing Specialist oversees the daily operations of the billing team, ensuring accurate, compliant, and timely submission of claims to maximize reimbursement.

Responsibilities

• Train and mentor new hires, provide side-by-side coaching, and assist with maintaining and updating billing procedure manuals.
• Prepare and submit claims, either electronically or by paper, to private health and County/State insurance companies.
• Contact insurance companies to correct billing issues and resubmit claims to third-party payers.
• Review remittances and perform follow-up and error correction to support re-billing of denied claims.
• Re-bill denied and all claims to a successful completion.
• Conduct regular audits of team data entry to ensure accuracy and strict adherence to HIPAA and other federal regulations.
• Serve as the primary point of contact for complex billing disputes, difficult insurance denials, and patient complaints.
• Monitor aging reports, track payer trends (e.g., Medicare, Medicaid, private insurers), and identify systemic issues causing claim delays.
• Create and maintain reports from the application database by tracking billings, monitoring collections, and compiling information.
• Identify billing errors by interpreting transactions and follow and report on the status of all billing transactions.
• Assist medical billing management with coordinating various billing functions to ensure proper execution of billing revenue cycle duties.
• Perform data validation and submission for other non-billing State reporting requirements.
• Review patient records daily for accuracy, supply any missing information, and ensure compliance with company policy and government regulations.
• Assist in establishing and maintaining security of medical records to ensure patient confidentiality on an ongoing basis.
• Access patient records as needed for review by physicians, technicians, and other medical staff members.
• Follow professional standards and meet requirements of local, state, and federal regulations.

Requirements

• High School graduate or GED.
• Three to five years of professional medical billing experience, with one to two years in a leadership or senior role preferred.
• Proficiency working in electronic health record systems (i.e., Cerner).
• Extensive knowledge of medical terminology, coding systems (ICD-10, CPT), and payer guidelines.
• Knowledge of basic medical professional coding and third-party operating procedures and practices.
• Ability to operate a computer, basic office equipment, and a multi-line telephone system.
• Must be well organized and detail oriented.

Essential Physical Requirements

• Must possess full range of body motion to pass basic FIT test for position, including walking, kneeling, standing, pushing, pulling, bending, stooping, reaching, and sitting for extended periods of time.
• Must be able to lift and carry up to 25 pounds.
• Manual dexterity needed for using a calculator and computer keyboard.