A Lead Billing Specialist oversees the daily operations of the billing team, ensuring accurate, compliant, and timely submission of claims to maximize reimbursement. Key duties include training staff, auditing records for coding accuracy (ICD-10/CPT), managing accounts receivable (AR), and resolving escalated claim denials.   

• Train and mentor new hires, provide side-by-side coaching, and assist with the maintaining and updating of billing procedure manuals.
• Prepare and submit claims, either electronically or by paper, to private health and County/State insurance companies. Contact insurance companies to correct billing issues and resubmit claims to third-party payers.
• Review remittances and take appropriate actions including: 
• Perform follow-up and error correction to support re-billing of denied claims. 
• Re-bill denied and all claims to a successful completion. 
• Conduct regular audits of team data entry to ensure accuracy and strict adherence to HIPAA and other federal regulations.  
• Serves as the primary point of contact for complex billing disputes, difficult insurance denials, and patient complaints. 
• Monitors aging reports, tracks payer trends (e.g., Medicare, Medicaid, private insurers), and identifies systemic issues causing claim delays.
• Create and maintain reports from the application database by tracking billings; monitoring collections; compiling information. 
• Identify billing errors by interpreting transactions. Follow and report on status of all billing transactions. 
• Assists medical billing management with coordinating various billing functions to ensure proper execution of billing revenue cycle duties.   
• Perform data validation and submission for other non-billing State reporting requirements.
• Review patient records daily for accuracy, supply any missing information and ensure compliance with company policy and government regulations.
• HIPAA - Assist in establishing and maintaining security of medical records to ensure patient confidentiality on an ongoing basis.
• Access patient records as needed for review by physicians, technicians and other medical staff members.
• Follow professional standards and meet requirements of local, state and federal regulations. 
• Other duties as assigned.  

• High School graduate or GED.
• Three - Five years of professional medical billing experience, with one – two years in leadership or senior role preferred
• Proficiency working in electronic health record systems (i.e. Cerner)
• Extensive knowledge of medical terminology, coding systems (ICD-10, CPT), and payer guidelines.
• Knowledge of basic medical professional coding and third-party operating procedures and practices.
• Ability to operate a computer, basic office equipment and multi-line telephone system. 
• Must be well organized and detail oriented.

Essential Physical Requirements:

• Must possess full range of body motion to pass basic FIT test for position to include walking, kneeling, standing, pushing, pulling, bending, stooping, reaching and sitting for extended periods of time.
• Must be able to lift and carry up to 25 pounds
• Manual dexterity needed for using a calculator and computer keyboard.