Medical Billing Claims Specialist - Lead

Summit Spine•Lawrenceville, FL

5d•Remote

About The Position

The Medical Billing Claims Team Lead is responsible for supporting the daily operations and performance of the medical billing claims team. This position provides day-to-day guidance to Claims Specialists, assists with training and development, performs quality audits, supports departmental workflow, and serves as the first point of escalation for routine staff questions and concerns. The Team Lead works closely with the Billing Supervisor and upper management to communicate departmental updates, monitor performance, address operational concerns, and ensure claims and month-end responsibilities are completed accurately and within established deadlines.

Requirements

Minimum of 3 years of experience as a Lead in medical billing or revenue cycle management within a medical setting.
Minimum of 3 years of experience in medical billing or revenue cycle management within a medical setting.
Previous experience providing day-to-day leadership, guidance, training, or oversight to billing staff preferred.
Experience with Medicare, Medicaid, commercial insurance plans, Workers’ Compensation, and Personal Injury cases.
Experience submitting claims for office visits, outpatient procedures, urinary drug screens, DME, MRI, and Chronic Care Management.
Strong knowledge of medical billing rules, including coordination of benefits, modifiers, EOBs, and ANSI denial codes.
Strong knowledge of CPT and ICD-10 coding and medical pre-certification protocols.
Excellent computer skills and familiarity with Microsoft Office.
Strong organizational and time-management skills with the ability to monitor multiple deadlines and priorities.
Ability to provide effective guidance and feedback to staff and escalate concerns appropriately.
Strong communication and interpersonal skills with the ability to work effectively with staff, management, providers, patients, and insurance representatives.
Comfortable working in a growing, dynamic organization and navigating change.
Self-motivated with the ability to multitask, prioritize work, and perform effectively in a fast-paced team environment.

Nice To Haves

Bachelor’s degree preferred.
Experience using eClinicalWorks preferred.
Experience in Pain Management preferred.

Responsibilities

Supervise and coordinate the daily activities of the Medical Billing Claims Specialist team.
Provide day-to-day guidance, support, and direction to Claims Specialists.
Serve as the first point of escalation for staff regarding general day-to-day duties, workflow questions, and routine operational concerns.
Perform audits of claims and batch submissions to ensure accuracy, completeness, and compliance with billing requirements.
Assist with training and onboarding of new Claims Specialists.
Provide coverage and support to the claims team when staff members are absent or additional departmental support is needed.
Communicate departmental updates, expectations, concerns, and performance issues directly to management.
Work directly with the Billing Supervisor and upper management to support departmental goals, workflow, and operational needs.
Conduct weekly team meetings and communicate relevant updates, expectations, and priorities to staff.
Report team updates, concerns, performance trends, and operational issues to management as appropriate.
Coordinate and monitor completion of month-end responsibilities and ensure established deadlines are met.
Work collaboratively with billing staff and management to maintain productivity, accuracy, and timely claims processing.
Audit claims to ensure information is complete and accurate prior to submission.
Ensure accurate and timely billing of HCFA 1500 claims.
Ensure files are properly documented with appropriate information, including date stamps, logs, signatures, and other required documentation.
Create and maintain provider logs for pending medical encounters and encounters requiring corrections.
Address billing inquiries from insurance companies, patients, and providers as appropriate.
Demonstrate knowledge of CPT, ICD-10, HCPCS coding, and modifiers.
Demonstrate knowledge of third-party payers, HMOs, PPOs, Medicare, Medicaid, Workers’ Compensation, Personal Injury, and other insurance plans.
Demonstrate knowledge of ERAs and EOBs.
Apply knowledge of payer-specific and LCD guidelines.
Understand health plan benefits, including deductibles, copays, coinsurance, and eligibility verification.
Maintain proficiency with spreadsheets, word processing applications, and Microsoft Office.
Work beyond normal scheduled hours when necessary to meet departmental deadlines and business needs.
Perform other duties and responsibilities as assigned by management.
Communicate professionally, respectfully, and effectively with patients, visitors, clinicians, coworkers, vendors, and management, including in busy, demanding, or stressful circumstances.
Maintain professional composure and consistently perform assigned duties throughout the scheduled work period.
Manage routine workplace stressors and feedback without disrupting patient care, patient-facing operations, departmental workflow, or coworkers’ work.
Exercise sound judgment, maintain appropriate workplace boundaries, provide and receive routine feedback and direction, appropriately escalate staff and operational concerns, protect confidential patient and business information, and address patient or workplace concerns through established supervisory and safety procedures.
Effectively lead and support staff, monitor departmental workflow and deadlines, communicate expectations, identify operational concerns, and assist management in maintaining accurate, timely, and efficient claims operations.