Billing Rep Lead

CommonSpirit Health•Rancho Cordova, CA

About The Position

The Billing Rep Lead helps patients and providers streamline billing and insurance processes. The role reviews and processes patient accounts, insurance claims, and payment postings, ensuring accurate and timely billing, following up on denied claims, and maintaining patient confidentiality. The position requires a solid understanding of accounts receivable, payer rules and regulations, contract language, CCI coding issues, DOFR interpretation, transaction effects on accounts, coordination of benefits rules, and offsets and recoups. The Billing Rep Lead determines which systems to use to locate information, including IDX, medical records systems, insurance payer websites, and Code Correct. The role analyzes account inventory for system issues, payer denial trends, and staff training needs; resolves claim edits; independently researches complex accounts; and may contact payers to verify compliance with workflows and policies. The position also tracks and compiles audit scores within expected turnaround times and works with the A/R Billing Supervisor to ensure compliance with billing regulations for discrepancies identified in audits.

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 dealing with internal and external customers.
Demonstrated ability to provide leadership to others.
Working knowledge of computers and proficiency with email systems, the internet, and Microsoft 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 Microsoft Excel skills to interpret and analyze high volumes of data.
Knowledge of Google Suite.

Responsibilities

Review and process patient accounts, insurance claims, and payment postings.
Ensure accurate and timely billing, follow up on denied claims, and maintain patient confidentiality.
Apply knowledge of payer rules and regulations, contract language, CCI coding issues, DOFR, account transactions, coordination of benefits, offsets, and recoups.
Determine the appropriate systems to use to locate relevant information, including IDX, medical records systems, insurance payer websites, and Code Correct.
Analyze inventory 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 as 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 compliance with billing regulations for discrepancies identified in audits.