Lead Billing Specialist

The Lead Billing Specialist is responsible for ensuring accurate billing, timely submission of electronic and/or paper claims, monitoring claim status, researching rejections and denials, documenting related account activities, and posting adjustments and collections of all payers. The Lead Billing Specialist must possess leadership skills, critical thinking skills, and a thorough understanding of Medicare, Medicaid, and commercial payer claim requirements to train new team members and answer questions. In addition, this position requires proficiency with the billing system to ensure all functionality is utilized for efficient processing of claims.

Essential Duties and Responsibilities:

• Reviews and resolves complex issues that result in payer denials, including appeals, coding corrections, medically necessity rules and other related functions.

• Contacts Provider Service Representatives to resolve repetitive payment and/or denial issues.

• Acts as a resource and support for the Billing Staff for complex issues.

• Analyzes and resolves billing issues, keeping A/R to no more than 10% over 60 days.

• Processes daily correspondence, claim status, handle denials, appeals and re-bills.

• Answers billing questions and inquiries from patients and internal staff.

• Updates patient files with address changes, contact information changes, etc., as needed.

• Relays updates regarding process and/or policy changes to team member and leadership when identified Efficiently navigates assigned insurance companies' proprietary websites to find policies, research payments, etc.

• Keeps supervisor apprised of matters regarding accounts receivable.

• Responds to requests from billing team in a timely fashion.

• Researches denials and submits correct claims/medical documentation.

• Reviews and manages claims within the work dashboard hold buckets for resolution.

• Manages team projects and assists with process implementation.

• Participates in conference calls, reviews accounts receivable reports, and/or creates reports to compile issues to expedite resolution of accounts.

• Exercises confidentiality in all areas, abiding by HIPAA rules and regulations.

• Assists with managing outsourced billing team to provide direction, feedback, and training as needed.

• Helps train new revenue cycle staff.

• Checks work e-mail on a regular basis throughout the workday.

• Participates in and complete all required trainings and in-services.

• Performs other duties as assigned.

Minimum Qualifications:

• High School Diploma, or equivalent WITH a minimum of five (5) years related experience with demonstrated increasing responsibility; OR an equivalent combination of education and/or experience.

• Must have knowledge of Internet and Microsoft Office software (MS Word, MS Excel, MS PowerPoint, MS Outlook).

• Must have excellent written and oral communication skills, including exceptional customer service.

• Must be able to establish and maintain effective working relationships with doctors, clinical staff, other co-workers and the public.

• Must be able to work individually as well as within a team.

• Must be able to follow both verbal and written instructions.

• Must be able to work a flexible schedule.

• Must be able to respond with patience and understanding during stressful conditions related to patient health and emergent situations.

• Must be able to multi-task and prioritize.

• Must demonstrate extreme attention to detail.

• Must possess strong organization skills.

• Must be able to problem solve and use reasoning.

• Must be able to meet predefined quality standards.

• Must maintain and project a professional attitude and appearance at all time.

• Must have a working knowledge of CPT and ICD-10 coding rules.

• Must have a solid foundation of insurance knowledge and guidelines for third party payers.

• Must have a working knowledge of the healthcare field and medical specialty, as well as medical terminology.

• All staff are expected to have a strong desire to provide excellent customer service; to comply with the rules and regulations of those organizations to which we are accountable; to have high ethical and professional standards of conduct; and to have an attitude of wanting to continuously improve their own professional performance.

Preferred Qualifications:

• Five (5) years experience working with an Electronic Medical Record (EMR).

• Medical Billing Certification

Driving/Travel:

The employee must have reliable transportation. While the primary workplace may be closest to the employees home, work assignments could be in any of the Companys locations.