Job Title: Billing Lead

Reports to: Revenue Cycle Manager

Department: Finance

FLSA Class: Non-Exempt

Updated: June 2024

Summary: The Billing Lead provides daily operational leadership to the Billing team. This position works with insurance companies and patients to promote growth of patient service revenue.

Job Responsibilities:

• Responsible for the accurate and timely submission of clean claims according to payer rules and guidelines.
• Serves as the Subject Matter Expert (SME) in matters relating to Billing and Coding processes and requirements. Provides training to staff (new and existing) as required.
• Monitors team production reports and adjusts workloads accordingly.
• Posts payments, slides, and adjustments to patient pay accounts accurately.
• Prepares and mails paper claims.
• Assists with reviewing and working aging monthly through Aging and other open bill reports.
• Communicates with patients, payers, attorneys and programs regarding claims, billing concerns or financial transactions.
• Attends insurance training sessions and other meetings as directed.
• Provides input to department manager on team performance and benchmarks.
• Manages and monitor clearinghouse and payer portal rejections and return to payer (RTP) claims daily.
• Handles any rebills or resubmits claims, as necessary.
• Builds relationships with third party payer provider relations representatives.
• Keeps up to date with changes regarding medical/dental billing rules and regulations.
• Maintains a positive teamwork environment.
• Maintains confidentiality and adheres to all HIPAA guidelines/regulations.
• Performs all other duties as assigned.

Qualifications:

• 1-3 years in administration or health care administration or related field preferred.
• Experience in medical insurance preferred.
• Knowledge of Medicare, Medicaid, private payer, workers compensation and third-party liability rules for accurate billing is required. Knowledge of FQHC billing preferred.
• High school diploma or GED required.
• Medical billing and/or medical coding certification preferred.
• Current working knowledge of ICD-9 coding is required, and ICD-10 and DSM coding knowledge, along with CPT (Level 1 HCPCS), Level 2 HCPCS and ADA codes is

Skills:

• Listens, identifies, and responds quickly and effectively to internal and external needs.
• Communicates effectively with all patients, providers and stakeholders.
• Displays organizational skills, abilities to multi-task, and uses time and resources effectively.
• Displays good judgment and decision-making skills.
• Effectively collaborates and seeks clarification and confirms accuracy as needed.
• Utilizes teamwork to achieve desired results and contributes to projects while developing positive working relationships.
• Pursues goals with commitment and takes initiative eagerly.
• Demonstrates accuracy, thoroughness, and reliability; manages time and priorities; develops and follows work procedures.
• Evaluates own performance and accepts constructive feedback to continue learning.

Physical and Mental Demands of the Job:

• Talking: The ability to speak effectively
• Average Hearing: The ability to hear average conversations and respond accordingly.
• Repetitive Motion: The employee is regularly required to sit; use hands to finger, handle, or feet. The employee is required to stand; walk; reach with hands.
• Finger Dexterity: Using primarily just the fingers to make small movements such as typing, picking up objects and pinching fingers together.
• Average Visual Abilities: Specific vision abilities required by this job include close vision, color vision and ability to adjust focus.
• Working Conditions: Works in a well-lit, climate-controlled environment. The noise level in the work environment is usually high. Potential exposure to infectious disease is possible.
• Physical Strength: The employee must occasionally lift and/or move up to 10 pounds.
• Mathematical Ability: Ability to add and subtract two-digit numbers and to multiply and divide with 10's and 100's.

The above statements are intended to describe the general nature and level of work being performed by people assigned to this job. This is not an exhaustive list of all duties and responsibilities associated with this job. Hunter Health Clinic Inc. reserves the right to amend and change responsibilities to meet business and organizational needs.