Billing Rep Lead

Dignity Health Medical Group•Rancho Cordova, CA

5d•$25 - $34

About The Position

The Billing Rep Lead helps patients and providers streamline the billing and insurance process by reviewing and processing patient accounts, insurance claims, and payment postings. The role supports accurate and timely billing, follows up on denied claims, and maintains patient confidentiality. The position requires a solid understanding of accounts receivable, payer rules and regulations, contract language, CCI coding issues, DOFR, coordination of benefits, offsets and recoups, and how transactions affect accounts. The Billing Rep Lead uses systems and resources such as IDX, medical records systems, insurance payer websites, and Code Correct to locate relevant information. The role analyzes inventory for system issues, payer denial trends, and staff training needs; resolves claim edits; researches complex accounts; and maintains audit scores while working with the A/R Billing Supervisor to ensure compliance with billing regulations.

Requirements

High school diploma or GED.
Five years of experience working in healthcare revenue cycle or a professional medical office.
One year of experience with the IDX practice management system.
Knowledge of physician billing regulations.
Understanding of professional claims and billing procedures.
Knowledge of federal and state regulations applicable to government and insurance collections.
Excellent written and verbal communication skills.
Ability to use a high level of judgment, initiative, and resourcefulness when working with internal and external customers.
Demonstrated ability to provide leadership to others.
Working knowledge of computers and demonstrated proficiency with email systems, the internet, and MS Office applications, particularly Word and Excel.

Nice To Haves

Associate degree or other qualification in healthcare administration or a related field.
One year of experience with Cerner EHR.
Strong MS Excel skills for interpreting and analyzing high volumes of data.
Knowledge of Google Suite.

Responsibilities

Review and process patient accounts, insurance claims, and payment postings.
Help ensure accurate and timely billing, follow up on denied claims, and maintain patient confidentiality.
Apply knowledge of accounts receivable, payer rules and regulations, contract language, CCI coding issues, DOFR, coordination of benefits, offsets and recoups, and transaction impacts.
Identify the appropriate systems and resources to locate pertinent information, including IDX, medical records systems, insurance payer websites, and Code Correct.
Analyze inventory in depth to identify potential system issues, payer denial trends, and staff training needs.
Resolve claim edits.
Independently research and analyze complex issues and accounts using available resources and tools.
Contact payers when needed to determine whether staff actions comply with current workflows and policies.
Maintain, track, and compile audit scores within the expected turnaround time.
Work with the A/R Billing Supervisor to ensure billing-regulation compliance for discrepancies identified in audits.