Lead Charges and Claims Specialist (Chesapeake Specialty Care)

University of Maryland Faculty Physicians•Annapolis, MD

About The Position

The Lead Charges and Claims Specialist serves as the subject matter expert and team lead for the Charges and Claims function. This position is responsible for overseeing daily charge and claim activities, ensuring the timely and accurate submission of claims, resolving complex billing issues, monitoring team performance, and providing training and support to Charges and Claims Specialists. The Lead works closely with providers, practice staff, and insurance carriers to optimize reimbursement, improve claim quality, and maintain compliance with regulatory and payer requirements. Maintain current knowledge of payer requirements, reimbursement policies, and regulatory updates. Identify trends impacting claims performance and recommend corrective actions. Develop and implement process improvements to enhance efficiency and reduce claim errors. Escalate significant billing or reimbursement concerns to the RCM Director. Assist with reporting, auditing, and special projects as assigned. Ensure all claims are submitted in accordance with payer guidelines and organizational standards. Participate in revenue cycle meetings and process improvement initiatives. Support departmental goals related to cash flow, claim acceptance, and reimbursement performance. Identify and resolve billing complaints and answer questions from staff, patients, and insurance companies.

Requirements

High school diploma or equivalent required
Minimum of 4–5 years of medical billing and claims experience
Strong knowledge of medical insurance plans including commercial, Medicare, Medicaid, and Tricare
Advanced understanding of claim submission, denial management, reimbursement methodologies, and payer policies
Familiarity with medical terminology and CPT, HCPCS, and ICD-10 coding
Experience with practice management systems, clearinghouses, and EHR platforms
Strong analytical and problem-solving abilities
Excellent communication, customer service, and leadership skills
Familiarity with Microsoft Office applications, including Word, Excel, and Outlook
Strong written and verbal communication skills, including the ability to confidently communicate with patients, providers, insurance representatives, and staff
Excellent organizational skills with the ability to manage multiple priorities and deadlines
Demonstrated ability to lead and develop a high-performing team

Nice To Haves

Associate degree in Healthcare Administration, Business, or related field preferred
Minimum of 1–2 years of leadership, supervisory, mentoring, or team lead experience preferred

Responsibilities

Overseeing daily charge and claim activities
Ensuring the timely and accurate submission of claims
Resolving complex billing issues
Monitoring team performance
Providing training and support to Charges and Claims Specialists
Working closely with providers, practice staff, and insurance carriers to optimize reimbursement, improve claim quality, and maintain compliance with regulatory and payer requirements
Maintaining current knowledge of payer requirements, reimbursement policies, and regulatory updates
Identifying trends impacting claims performance and recommending corrective actions
Developing and implementing process improvements to enhance efficiency and reduce claim errors
Escalating significant billing or reimbursement concerns to the RCM Director
Assisting with reporting, auditing, and special projects as assigned
Ensuring all claims are submitted in accordance with payer guidelines and organizational standards
Participating in revenue cycle meetings and process improvement initiatives
Supporting departmental goals related to cash flow, claim acceptance, and reimbursement performance
Identifying and resolving billing complaints and answering questions from staff, patients, and insurance companies