Lead Charges and Claims Specialist (Chesapeake Specialty Care)
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.
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.
- 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.
Benefits
- The referenced base salary range represents the low and high end of Chesapeake Specialty Care salary range for this position.
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Education Level
High school or GED
