Lead Billing Specialist, Tier I

FAMILY HEALTH CARE CENTER OF KALAMAZOO•Kalamazoo, MI

About The Position

The Lead Billing Specialist Tier I oversees daily billing operations, resolves complex claims and denials, and ensures billing processes are accurate, efficient, and compliant with company policies. The role is a key resource for staff, patients, payers, and internal teams, providing customer support, training, and guidance. It also monitors billing performance through reporting and audits and identifies improvements to strengthen revenue cycle efficiency. The position promotes collaboration, ethical conduct, organizational support, and safety and security, including appropriate use of electronic medical record systems and IT resources. Duties may be modified based on the organization’s needs.

Requirements

Minimum of a high school diploma.
Experience with payer appeals processes.
Knowledge of FQHC policies and requirements.
Exceptional customer service skills.
Strong analytical skills.
Knowledge of FQHC or RHC billing rules and regulations.

Nice To Haves

CPC or CPB certification.
An associate degree in Business with an emphasis in Accounting or Finance from an accredited college or university, in addition to two years of experience, or an equivalent combination of education and experience.
Knowledge of the EPIC system and relevant third-party liability (TPL) and government websites, such as CHAMPS, C-SNAP, Connex, Medicare DDE, Availity, and HMO Medicaid sites used by FHC.
Working knowledge of ICD-10, HCPCS, and CPT.

Responsibilities

Oversee daily billing activities and ensure processes are efficient, accurate, and consistent with company policies.
Resolve complex claims, denials, and unpaid balances, including managing appeals.
Investigate and resolve billing questions and problems for staff, patients, and payers.
Prepare and review reports to monitor billing performance and identify areas for improvement.
Communicate with and support patients and staff regarding billing inquiries.
Provide billing guidance and training to other billers and departments, including support for workflow improvements.
Promote safety precautions and security measures for staff and patients.
Adhere to data security guidelines, including appropriate use of EMR systems and IT resources.
Complete administrative tasks accurately and on time; prioritize and plan work activities.
Coordinate projects, develop implementation plans, include staff in planning and process improvement, and communicate project changes and progress.
Provide staff with regular performance feedback and support individual team members’ skill development.