HOSPITAL BILLING LEAD

Horizon Health•Paris, IL

just now•$24 - $38•Onsite

About The Position

The Hospital (HB) Billing Lead serves as the department's senior technical resource, providing day-to-day workflow coordination, technical guidance, and functional leadership for Hospital (HB) Billing operations. Working under the direction of the Central Business Office Supervisor, the Lead supports daily billing activities by coordinating workflow, monitoring claim quality, assisting with staff development, resolving routine operational issues, and serving as the primary technical resource for Hospital (HB) Billing team. While this position does not typically have direct supervisory responsibility, the Lead provides functional leadership through coaching, mentoring, technical expertise, and promotion of departmental best practices. The Hospital (HB) Billing Lead maintains advanced knowledge of Hospital (HB) Billing operations supporting Critical Access Hospital (CAH), Hospital Outpatient (HOP), Emergency Department, Observation, Surgery, Ancillary Services, Hospital-Based (HB) Clinics, Emergency Medical Services (EMS), and other applicable facility service lines. The Lead maintains expertise in facility claim preparation, UB-04 billing, reimbursement methodologies, payer requirements, billing regulations, electronic claim processing, reimbursement policies, and Revenue Cycle best practices while promoting operational consistency, billing accuracy, productivity, customer service, regulatory compliance, and continuous improvement. Serving as the department's subject matter expert, the Lead assists with onboarding, education, workflow improvement, quality monitoring, testing, implementation of operational initiatives, and resolution of complex billing issues. The Hospital (HB) Billing Lead collaborates with Patient Access, Financial Clearance, Coding & Revenue Integrity, Health Information Management (HIM), Finance, Information Technology, clinical departments, and other Revenue Cycle teams to resolve billing issues, improve workflows, reduce reimbursement risk, and promote accurate, timely, and compliant claim submission across all facility service lines. The Lead maintains an understanding of the unique reimbursement and operational requirements associated with Critical Access Hospital (CAH), Hospital Outpatient (HOP), Hospital-Based (HB) Clinics, Emergency Medical Services (EMS), and other applicable care settings to support organizational Revenue Cycle objectives. The Hospital (HB) Billing Lead is expected to model Horizon Health's values through professionalism, accountability, collaboration, technical excellence, integrity, and a commitment to exceptional customer service while fostering operational consistency and supporting the success of both the department and the organization.

Requirements

High School Diploma or General Education Degree (GED) required.
Associate's or Bachelor's degree in Business Administration, Healthcare Administration, Health Information Management, Accounting, Finance, or a related field preferred.
Equivalent combinations of education and directly related experience may be considered.
Two (2) to four (4) years of progressively responsible Hospital (HB) Billing, Patient Accounting, Revenue Cycle, or healthcare financial operations experience required.
Demonstrated advanced technical knowledge of Hospital (HB) Billing operations, facility reimbursement methodologies, claim processing, payer requirements, billing regulations, and reimbursement policies required.
Demonstrated experience processing and resolving complex billing issues, claim edits, reimbursement questions, payer requirements, and claim exceptions.
Demonstrated experience training, onboarding, coaching, mentoring, or serving as a technical resource for team members preferred.
Previous Lead, Senior Specialist, or advanced technical resource experience preferred.
Experience supporting Hospital (HB) Billing operations within Critical Access Hospital (CAH), Hospital Outpatient (HOP), Emergency Department, Observation, Surgery, Ancillary Services, Hospital-Based (HB) Clinics, Emergency Medical Services (EMS), or similar healthcare environments preferred.
Maintains a working knowledge of Revenue Cycle operations across the organization's care settings and billing environments, including Critical Access Hospital (CAH), Hospital Outpatient (HOP), Hospital-Based (HB) Clinics, Professional Billing (PB), Emergency Medical Services (EMS), and other applicable service lines, with an understanding of the unique operational, reimbursement, regulatory, and compliance requirements associated with each.
Demonstrates advanced knowledge of Hospital (HB) Billing reimbursement methodologies, facility billing requirements, and payer-specific regulations applicable to Critical Access Hospital (CAH), Hospital Outpatient (HOP), Emergency Department, Observation, Surgery, Ancillary Services, Hospital-Based (HB) Clinics, Emergency Medical Services (EMS), and other facility service lines.
Maintains working knowledge of Medicare, Medicaid, commercial payer, managed care, workers' compensation, Veterans Affairs (VA), and other governmental reimbursement methodologies applicable to Hospital (HB) Billing.
Demonstrates advanced knowledge of UB-04 claim preparation, revenue codes, HCPCS/CPT coding relationships, modifiers, National Correct Coding Initiative (NCCI) edits, medical necessity requirements, outpatient reimbursement methodologies, and applicable payer billing guidelines.
Understands the relationship between Hospital (HB) Billing, Professional (PB) Billing, Patient Access, Financial Clearance, Coding & Revenue Integrity, Health Information Management (HIM), clinical operations, Finance, and the overall Revenue Cycle to support accurate reimbursement and coordinated patient financial services.
Thorough knowledge of Hospital (HB) Billing processes, UB-04 claim preparation, electronic claim submission, reimbursement methodologies, payer billing requirements, and facility billing operations.
Advanced knowledge of Medicare, Medicaid, commercial payer, managed care, workers' compensation, Veterans Affairs (VA), and other governmental billing requirements applicable to Hospital (HB) Billing.
Working knowledge of revenue codes, HCPCS/CPT coding relationships, modifiers, National Correct Coding Initiative (NCCI) edits, medical necessity requirements, outpatient reimbursement methodologies, and billing compliance standards.
Ability to research payer billing requirements, claim edits, reimbursement policies, regulatory guidance, and billing regulations to support accurate and compliant claim submission.
Demonstrated ability to identify billing trends, reimbursement risks, claim quality concerns, payer issues, workflow barriers, and operational improvement opportunities.
Demonstrated ability to provide technical guidance, education, mentoring, and workflow support regarding billing regulations, payer requirements, reimbursement policies, claim processing, and departmental best practices.
Strong analytical, organizational, problem-solving, communication, and critical thinking skills with exceptional attention to detail.
Demonstrated proficiency utilizing electronic health records (EHR), patient accounting systems, Hospital (HB) Billing applications, claim editing software, clearinghouses, payer portals, Revenue Cycle applications, and other technology supporting Hospital (HB) Billing operations.
Proficiency with Microsoft Office applications, including Outlook, Word, and Excel.
Ability to interpret and utilize operational reports, billing dashboards, work queues, claim edit reports, denial reports, reimbursement reports, productivity reports, and system-generated performance data to monitor workflow and support operational decision-making.
Experience participating in system implementations, workflow redesign, testing, optimization, or technology enhancement initiatives preferred.
Demonstrated ability to coach, mentor, and provide technical guidance to team members.
Ability to coordinate workflow and prioritize work assignments without formal supervisory authority.
Ability to influence peers through technical expertise, collaboration, and professionalism.
Demonstrated leadership through mentoring, communication, and subject matter expertise.
Ability to build collaborative relationships across Revenue Cycle departments.
Strong customer service orientation and ability to professionally resolve complex billing issues.
Ability to maintain confidentiality and exercise sound judgment.
Demonstrated professionalism, accountability, adaptability, integrity, and commitment to organizational values.
Demonstrated ability to interpret billing reports, work queues, claim edit reports, denial trends, reimbursement data, productivity reports, and quality metrics.
Uses operational and financial data to identify workflow barriers, claim quality concerns, reimbursement risks, payer trends, educational opportunities, and operational improvement initiatives.
Assists department leadership with monitoring billing productivity, claim quality, reimbursement performance, work queue aging, operational efficiency, and departmental performance indicators.
Identifies recurring payer issues, billing trends, system opportunities, and workflow improvements while communicating findings and recommendations to department leadership.
Supports quality initiatives, workflow redesign, testing, implementation, staff education, and continuous process improvement activities.
Promotes operational consistency, billing quality, reimbursement integrity, and continuous improvement through education, workflow standardization, and technical support.

Responsibilities

Serves as the primary technical resource for Hospital (HB) Billing team by providing day-to-day guidance, workflow coordination, and subject matter expertise.
Coordinates daily work activities to support timely, accurate, and compliant billing operations while assisting leadership with workload distribution and workflow priorities.
Monitors departmental work queues, claim inventories, billing edits, and operational workflows to identify barriers, prioritize work, and support timely claim submission.
Assists staff with resolving complex billing questions, claim issues, payer requirements, reimbursement concerns, and operational challenges.
Provides real-time coaching, technical guidance, and workflow support to promote consistent billing practices and operational efficiency.
Assists with onboarding, orientation, competency development, and ongoing education of Hospital (HB) Billing team.
Promotes standardized workflows, departmental procedures, organizational policies, and Revenue Cycle best practices.
Escalates operational concerns, reimbursement risks, system issues, and workflow barriers to department leadership while assisting with development and implementation of solutions.
Serves as the department's subject matter expert for Hospital (HB) Billing operations supporting Critical Access Hospital (CAH), Hospital Outpatient (HOP), Emergency Department, Observation, Surgery, Ancillary Services, Hospital-Based (HB) Clinics, Emergency Medical Services (EMS), and other applicable facility service lines.
Provides technical guidance regarding UB-04 claim preparation, facility billing requirements, reimbursement methodologies, payer billing regulations, electronic claim submission, and reimbursement policies.
Coordinates and provides technical guidance for the resolution of claim edits, billing exceptions, payer rejections, electronic claim errors, reimbursement issues, and other complex billing scenarios.
Researches payer policies, reimbursement regulations, claim processing requirements, billing guidelines, and regulatory updates to support compliant billing practices.
Identifies billing trends, recurring claim edits, payer issues, reimbursement risks, and workflow opportunities while recommending operational improvements.
Identifies recurring claim edits, reimbursement trends, charging issues, and billing opportunities while collaborating with Coding & Revenue Integrity, Patient Access, clinical departments, and Information Technology to improve charge capture, claim quality, reimbursement accuracy, and overall Revenue Cycle performance
Assists with development, implementation, and maintenance of standardized billing procedures, reference materials, and departmental workflows.
Supports accurate charge reconciliation, claim quality, reimbursement integrity, and timely claim submission across all Hospital (HB) Billing operations.
Assists with implementation of regulatory changes, payer updates, system enhancements, workflow redesign, and operational improvement initiatives impacting Hospital (HB) Billing.
Promotes compliance with federal, state, local, payer, and organizational billing regulations, policies, and procedures.
Assists with monitoring claim quality, billing accuracy, reimbursement integrity, documentation requirements, and departmental quality standards.
Identifies compliance concerns, reimbursement risks, recurring billing issues, and operational trends while communicating findings to leadership.
Supports internal audits, quality reviews, payer audits, regulatory reviews, and corrective action initiatives.
Promotes accurate application of billing regulations, reimbursement methodologies, payer requirements, and organizational policies.
Assists with education related to regulatory updates, payer changes, billing requirements, and compliance initiatives.
Collaborates with Patient Access, Financial Clearance, Coding & Revenue Integrity, Health Information Management (HIM), clinical departments, Finance, Information Technology, and other Revenue Cycle departments to resolve billing issues and improve operational performance.
Serves as a departmental resource during implementation of workflow improvements, system enhancements, technology initiatives, and organizational projects.
Supports communication between Hospital (HB) Billing and operational departments to improve claim quality, reimbursement accuracy, and Revenue Cycle performance.
Participates in multidisciplinary meetings, operational workgroups, educational initiatives, and process improvement activities.
Promotes collaboration and positive working relationships throughout the Revenue Cycle and organization.
Assists leadership with monitoring departmental productivity, work queue performance, claim quality, reimbursement trends, billing timeliness, and operational performance indicators.
Utilizes operational reports, dashboards, and performance metrics to identify workflow barriers, quality concerns, reimbursement risks, and educational opportunities.
Recommends workflow improvements that enhance operational efficiency, billing quality, customer service, and reimbursement outcomes.
Assists leadership in identifying educational needs, workflow opportunities, and operational priorities based on productivity, quality, reimbursement, and performance data.
Supports continuous improvement initiatives through technical expertise, workflow standardization, education, and process optimization.
Maintains current knowledge of billing regulations, reimbursement methodologies, payer requirements, Revenue Cycle best practices, and emerging healthcare trends.
Serves as a subject matter expert for Hospital (HB) Billing operations, system functionality, and departmental workflows.
Assists with onboarding, competency validation, cross-training, continuing education, and staff development initiatives.
Participates in system testing, implementation, optimization, workflow redesign, and operational improvement projects.
Assists leadership with development and maintenance of departmental policies, procedures, workflow documentation, and educational resources.
Supports implementation of payer updates, regulatory changes, reimbursement initiatives, and technology enhancements affecting Hospital (HB) Billing operations.
Performs other duties as assigned in support of departmental and organizational objectives.