Lead Billing Specialist
About The Position
The Lead Billing Specialist provides operational oversight and leadership to the Billing Specialist team, ensuring accurate, compliant, and timely claim submission for hospital and physician services. The role supervises daily workflow, monitors billing performance indicators, identifies trends, and implements improvements to optimize reimbursement and clean claim rates. The Team Lead partners with Coding, CDI, Patient Access, Denials, Follow-Up, Revenue Integrity, and clinical departments to resolve billing edits and front-end issues. The position also trains, mentors, and develops team members and ensures adherence to payer regulations, compliance standards, and organizational policies. Attention to detail, data-driven decision-making, strong payer knowledge, and leadership through influence are essential.
Requirements
- High school diploma or equivalent.
- At least 7 years of electronic billing and/or billing edit experience in a 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 of leadership, senior specialist, or mentoring experience.
- Certified Revenue Cycle Specialist (CRCS).
- Certified Professional Coder—Hospital Services (CPC).
- Certified Coding Specialist (CCS).
- Certified Revenue Cycle Representative (CRCR).
- Epic Resolute experience.
Responsibilities
- Oversee daily pre-bill and post-bill edit resolution to ensure timely claim release.
- Monitor workqueues, claim scrubber edits, and billing reports to ensure productivity and quality standards are met.
- Ensure claims are submitted within payer timely filing guidelines.
- Prioritize workload to meet departmental KPIs, including Clean Claim Rate, DNFB/Pre-AR Days, Initial Denial Rate, and Timely Filing.
- Review billing-related denials to identify trends and implement corrective action plans.
- Monitor hardcopy claim processing and supporting documentation requirements.
- Escalate payer issues and partner with leadership to resolve systemic barriers.
- Ensure accurate use of UB-04 and CMS-1500 claim forms and required data elements.
- Conduct quality audits of team members' work and provide improvement feedback.
- Lead rebill projects and coordinate special initiatives assigned by leadership.
- Assist in developing onboarding training for new Billing Specialists.
- Conduct ongoing education on 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.
- Identify skill gaps and develop targeted retraining plans.
- Coach team members through performance improvement opportunities and promote cross-training.
- Review daily, weekly, and monthly billing indicators and dashboards.
- Track individual and team productivity, quality, and denial trends.
- Report performance metrics to the Supervisor, Manager, or Director.
- Identify workflow bottlenecks and recommend process redesign.
- Collaborate with Revenue Integrity and Coding to reduce preventable edits.
- Support department-wide initiatives to improve first-pass resolution and clean claim rates.
- Ensure adherence to state and federal billing regulations and government and commercial payer billing requirements.
- Support internal audits and compliance reviews and promote ethical billing practices and integrity standards.
Benefits
- Great benefits.
Stand Out From the Crowd
Upload your resume and get instant feedback on how well it matches this job.
What This Job Offers
Job Type
Full-time
Career Level
Senior
Education Level
High school or GED
