Medical Biller Lead

Whitman Hospital and Medical Clinics • Colfax, WA

1d • Onsite

About The Position

The Medical Biller Lead is responsible for assisting in the day-to-day billing operations in Patient Financial Services. Acts as an instructor and trainer for billing procedures and processes. Assists the Manager with activities related to development, implementation and maintenance of billing operations in compliance with Federal and State laws. The Medical Billing Lead provides active oversight of staff operations by tracking daily workflow completion, reinforcing accountability, and ensuring all assigned duties are performed accurately, efficiently, and in alignment with organizational standards and deadlines. This includes working closely with department members as well as patients, insurance payers, other WHMC managers and teams, and clients to ensure accurate billing, timely reimbursement, and a positive experience for patients. This role supports hospital and clinic services in a Critical Access Hospital (CAH) environment and requires an understanding of payer requirements, revenue cycle workflows, and customer service excellence. The Medical Biller Lead is responsible for coordinating compliant billing workflows, performing audits as necessary to ensure quality standards are met and maintained, and for assigning work as needed to ensure accounts are handled accurately, efficiently, and compassionately.

Requirements

• High school diploma or GED.
• Minimum of 5 years of hospital billing experience.
• Strong understanding of UB-04 claims, revenue codes, and hospital billing workflows.
• Experience with hospital denial management and payer appeals.
• Experience billing Medicare and Medicaid hospital claims.
• Knowledge of ICD-10, CPT and HCPC codes and hospital charging and billing concepts.
• Strong computer skills in data entry, and knowledge of Microsoft Office Suite

Nice To Haves

• Working knowledge of Epic HB strongly preferred.
• Experience billing in a Critical Access Hospital
• Associate’s degree in healthcare administration, business, or related field.
• Completion of medical billing terminology courses
• Certified for billing and/or Compliance or Revenue Cycle via HFMA AHIMA, AAPC, etc.

Responsibilities

• Serve as an escalation point for complex patient billing inquiries, ensuring clear, compassionate, and timely resolution while modeling excellent customer service standards for staff.
• Provide guidance and oversight to staff in educating patients on financial responsibility, insurance coverage, payment options, and charity care processes.
• Support staff in handling payment arrangements, financial assistance applications, and Good Faith Estimates, ensuring consistency and compliance.
• Monitor and ensure timely resolution of patient concerns, reinforcing professionalism, empathy, and service excellence across the team.
• Oversee daily billing operations to ensure accurate and timely preparation and submission of clean claims (UB-04 and/or professional) in compliance with payer requirements.
• Review and assist with resolution of claim edits, holds, and errors, providing direction to staff to prevent submission delays.
• Ensure appropriate handling of corrected, replacement, and adjusted claims, and monitor coordination of primary, secondary, and tertiary billing processes.
• Provide leadership and direction in accounts receivable follow-up activities, ensuring timely and effective resolution of unpaid, underpaid, and denied claims.
• Support staff in analyzing remittance advice (ERA/EOB) for payment accuracy and identifying reimbursement discrepancies.
• Oversee denial management processes, including research and resolution of denials related to coding, medical necessity, authorizations, and eligibility.
• Identify denial trends and partner with coding, clinical departments, and front-end teams to implement corrective actions and prevent recurrence.
• Escalate complex reimbursement issues appropriately and collaborate with leadership on resolution strategies.
• Lead denial trending, reporting, and performance improvement initiatives to enhance reimbursement outcomes and reduce accounts receivable days.
• Ensure accurate and compliant account documentation within Epic and adherence to established workflows.
• Monitor Epic HB work queues, dashboards, and reporting tools to prioritize workload and ensure productivity standards are met.
• Identify workflow inefficiencies or system issues within Epic and coordinate with leadership on optimization, upgrades, and testing efforts.
• Maintain accurate account notes, claim statuses, and follow-up actions in Epic.
• Participate in Epic upgrades, testing, and optimization efforts related to hospital billing and reimbursement.
• Ensure compliance with Centers for Medicare & Medicaid Services (CMS), Medicare, Medicaid, and other payer regulations across all billing activities.
• Support internal and external audits, payer reviews, and medical record requests, ensuring timely and accurate responses.
• Assist leadership with data analysis and reporting related to reimbursement, cost reporting, and revenue cycle performance metrics.
• Maintain adherence to hospital policies, HIPAA requirements, and all billing compliance standards.
• Provide day-to-day guidance, training, and mentorship to billing staff, promoting accountability, accuracy, and continuous development.
• Monitor staff productivity, quality, and workflow completion, addressing performance issues and recognizing achievements as appropriate.
• Coordinate cross-coverage within Patient Financial Services and Patient Access to ensure continuity of operations.
• Participate in department meetings, training initiatives, and ongoing process improvement efforts, contributing to a culture of collaboration and excellence.
• Promotes a Positive Working Environment
• Conducts oneself in line with organization’s mission, values and standards of behavior.
• Consistently adheres to organizational policy.
• Supports and maintains a culture of safety and quality.
• Participates in committees as assigned.
• Communicates Effectively
• Builds relationships and works collaboratively with other staff.
• Provides timely operational updates to supervisor.
• Responds to communications in a timely manner.
• Performs Duties Efficiently and Effectively
• Assists in development of department schedule and other assigned staffing needs.
• Serves as preceptor for new staff
• Provides guidance and education for existing staff.
• Assists in identifying department process improvements.
• Provides guidance to others in same position
• Functions as EHR superuser.
• Acts in compliance with applicable federal, state, and local regulations.
• Performs other duties as assigned.

Benefits

• medical
• dental
• vision
• life insurance
• retirement options (403(b) & 457)
• Medical insurance coverage begins on day one and is available to both full time and part time employees.
• discounts on medical services provided by Whitman Hospital and Medical Clinics.
• Differentials apply for evening, night, and weekend shifts.
• unique PTO plan enables employees to increase their accrual with each year of service!

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: High school or GED
• Number of Employees: 11-50 employees