Medical Billing and Coding Analyst 3

Enterprise Mangement Solutions Inc•Baltimore, MD

2d•Remote

About The Position

The Medical Billing & Coding Analyst (Team Lead – Team A) provides advanced billing, coding, and revenue cycle oversight services for outpatient mental health center clients. The Team Lead ensures that documentation supports services rendered, all billable services are captured and submitted, and claims are accurately adjudicated and paid. This role performs continuous analysis of billing and payment activity, identifies gaps (missing documents, missed charges, denials, underpayments, no-pay claims), and coordinates timely resolution. The Team Lead collaborates with the Prior Authorization Unit, Accounts Receivables leadership, and operational management of client companies to ensure alignment across authorization, documentation, billing, and reimbursement.

Requirements

Strong knowledge of U.S. medical billing and coding standards (CPT, ICD-10-CM, HCPCS)
Strong understanding of end-to-end revenue cycle management, especially A/R follow-up and payment reconciliation
Ability to analyze billing workflows, identify revenue leakage, and implement corrective actions
Ability to oversee, coach, and quality-check biller output consistently (Team A)
Strong attention to detail and documentation discipline
Excellent written and verbal English communication
Proficiency in EHR systems, billing software, clearinghouses, and payer portals
Professional, audit-ready work practices and secure handling of PHI
Bachelor’s degree or equivalent experience preferred
Minimum 3–5 years of U.S. medical billing and coding experience
Prior Team Lead / workflow oversight experience required
Ability to pass background and reference checks (as required by client/contract)

Nice To Haves

Behavioral health and outpatient mental health billing experience preferred
Outpatient mental health billing experience strongly preferred
Coding certifications (e.g., CPC, CCS) preferred

Responsibilities

Perform and oversee billing and coding in compliance with CPT, ICD-10-CM, HCPCS, and payer-specific billing rules
Review documentation to confirm medical necessity support and correct code assignment prior to claim submission
Ensure all required clinical and administrative documentation is entered into the EHR prior to billing (e.g., signed notes, treatment plans, required forms, demographics/insurance data)
Ensure all billable services are captured and billed, including identification and correction of missed charges
Oversee claim submission processes to ensure timely, accurate, and compliant claim filing
Analyze biller work output and billing queues for completeness, accuracy, and timeliness
Monitor claim status, rejections, denials, and payer correspondence; coordinate corrections and resubmissions
Reconcile payments to billed services and contracted rates; identify and escalate underpayments, no-pay claims, and payment discrepancies
Lead Team A workflow: assign daily work, manage throughput, and ensure consistent execution across Medical Biller & Coder 1 and Medical Biller & Coder 2
Conduct routine quality assurance reviews of team output; document findings and provide corrective coaching
Track and report revenue cycle risks (documentation gaps, authorization gaps, denial trends, aging A/R) to the Accounts Receivables Department Manager
Collaborate with the Prior Authorization Unit to ensure services billed are authorized where required and align with approved service periods and units
Collaborate with operational management of the client companies to resolve documentation delays, clinical workflow gaps, scheduling/billing mismatches, and process barriers impacting reimbursement
Maintain accurate internal trackers, reconciliation logs, and audit-ready records as required by the Company
Assist the Accounts Receivables Department Manager with escalations, special projects, and revenue cycle improvement initiatives as requested
Support internal and external audits (payer audits, compliance reviews) by producing billing support, reconciliation documentation, and QA evidence
Participate in cross-training activities and cover essential functions during team absences or high-volume periods
Contribute to performance improvement plans related to denial reduction, A/R reduction, clean claim rate improvement, and documentation completeness
Maintain strict confidentiality of PHI and financial information and comply with all security requirements
Maintain awareness of relevant regulations, payer policy changes, and company procedures impacting billing operations