Billing Follow Up Representative Lead

Advocate Health and Hospitals Corporation • Sheboygan, WI

1d • Remote

About The Position

This is a full-time, fully remote position within the Enterprise Revenue Cycle - PB Billing Support Operations department. The role focuses on daily claims submissions, resolving charging issues, reporting trends, and potentially collecting on assigned insurance receivables. The Lead will review accounts, respond to inquiries, apply contractual allowances, and assist the team with complex issues, training, and feedback. They will also monitor productivity and quality, analyze statistics, and provide feedback to other Billing Representatives. The position involves attending meetings, sharing training knowledge, staying updated on payer changes, and resolving advanced projects. Additionally, the Lead will research and distribute new information from insurance payers regarding contracts, guidelines, and system updates.

Requirements

• Proficient in all follow up rep functions.
• Demonstrated ability to work and solve billing / follow up issues in a healthcare environment.
• Broad and comprehensive knowledge and understanding of department-specific procedures.
• Strong analytic, organization, communication (written and verbal), and interpersonal skills.
• Ability to successfully lead, coach, and train a team, and problem solve complex accounts.
• Knowledge of medical terminology, coding terminology (CPT, ICD- 10, HCPC), and insurance/reimbursement practice.
• Able to use Zoom, Microsoft office, or other communication software for meetings.
• High School Diploma or General Education Degree (GED)
• Typically requires 5 years of related experience in medical/billing reimbursement environment, or equivalent combination of education and experience.

Responsibilities

• Responsible for daily claims submissions to the appropriate payer source.
• Communicates with internal and external parties to resolve charging issues affecting the claims.
• Reports trends with other departments that may improve the claims submission process.
• May be responsible for collection of an assigned section of the insurance receivables, following all procedures and guidelines established.
• Reviews assigned accounts and takes appropriate course of action: internal or external problems that may cause a delay in reimbursement.
• Responds to telephone or written correspondence from internal and external parties regarding insurance claims.
• Applies contractual allowances where necessary.
• Assists team with more complex issues to resolve problems, provides necessary training, and provides ongoing feedback on performance.
• Monitors and audits productivity, quality and analyzes daily statistics looking for any trends which are reported to management.
• May provide feedback to Billing Rep I and II.
• Attends and participates in meetings as required, attend outside seminars and be used as “train the trainer”.
• Share training knowledge with others as appropriate.
• Keeps abreast with insurance payor updates/changes and assists management with recommendations for implementation.
• Prioritize rejections to avoid timely filing insurance appeal limitations, may include denials.
• Accountable to assess and resolve advanced projects as assigned.
• Research/Distribute new upgrades/information from the Insurance Payers re: Contracts, guidelines, reimbursement rules and regulations and for computer systems.

Benefits

• Paid Time Off programs
• Health and welfare benefits such as medical, dental, vision, life, and Short- and Long-Term Disability
• Flexible Spending Accounts for eligible health care and dependent care expenses
• Family benefits such as adoption assistance and paid parental leave
• Defined contribution retirement plans with employer match and other financial wellness programs
• Educational Assistance Program

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: High school or GED