Lead Billing Specialist
About The Position
The Billing Team Lead provides operational oversight and leadership to the Billing Specialist team to ensure accurate, compliant, and timely claim submission for hospital and physician services. This role is responsible for supervising daily workflow, monitoring key billing performance indicators, identifying trends, and implementing process improvements to optimize reimbursement and clean claim rates. The Team Lead partners closely with Coding, CDI, Patient Access, Denials, Follow-Up, Revenue Integrity, and clinical departments to ensure billing edits and front-end issues are resolved efficiently. This position plays a critical role in training, mentoring, and developing team members while ensuring adherence to payer regulations, compliance standards, and organizational policies. Attention to detail, data-driven decision-making, strong payer knowledge, and the ability to lead through influence are essential to success in this role.
Requirements
- High School Diploma or equivalent required
- 7+ years of electronic billing and/or billing edit experience in hospital and/or physician setting
- Working knowledge of HCPCS, CPT-4, ICD-10, and medical terminology
- Strong understanding of payer requirements and claims processing regulations
Nice To Haves
- 1-2 years leadership, senior specialist, or mentoring experience preferred
- Certified Revenue Cycle Specialist (CRCS)
- Certified Professional Coder- Hospital Services (CPC)
- Certified Coding Specialist (CCS)
- Certified Revenue Cycle Representative (CRCR)
- Epic Resolute
Responsibilities
- Oversees daily pre-bill and post-bill edit resolution to ensure timely claim release.
- Monitors workqueues, claim scrubber edits, and billing reports to ensure productivity and quality standards are met.
- Ensures claims are submitted within payer timely filing guidelines.
- Prioritizes workload to meet departmental KPIs (Clean Claim Rate, DNFB/Pre-AR Days, Initial Denial Rate, Timely Filing).
- Reviews billing-related denials to identify trends and implement corrective action plans.
- Monitors hardcopy claim processing and supporting documentation requirements.
- Escalates payer issues appropriately and partners with leadership to resolve systemic barriers.
- Ensures accurate use of UB-04 and CMS-1500 claim forms and required data elements.
- Conducts quality audits of team members’ work and provides feedback for improvement.
- Leads rebill projects and coordinates special initiatives assigned by leadership.
- Assist in developing onboarding training for new Billing Specialists.
- Conducts ongoing education related to CPT, HCPCS, and ICD-10 updates, Payer billing guidelines, Epic or billing system enhancements, and Compliance and regulatory updates.
- Assist in maintaining job aids, workflow guides, and reference materials.
- Identifies skill gaps and develops targeted retraining plans.
- Coaches team members through performance improvement opportunities.
- Promote cross-training to support operational flexibility.
- Reviews daily, weekly, and monthly billing indicators and dashboards.
- Tracks individual and team productivity, quality, and denial trends.
- Reports on the performance metrics to Supervisor/Manager/Director.
- Identifies workflow bottlenecks and recommends process redesign.
- Collaborates with Revenue Integrity and Coding to reduce preventable edits.
- Supports department-wide initiatives to improve first-pass resolution and clean claim rates.
- Ensures adherence to state and federal billing regulations.
- Maintains compliance with government and commercial payer billing requirements.
- Supports internal audits and compliance reviews.
- Promotes ethical billing practices and integrity standards.
Benefits
- Great Benefits
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Education Level
High school or GED
