Billing Team Lead

Job Description

Job DescriptionDescription:

The Billing Team Lead within Revenue Cycle Operations serves as the frontline leader for a team of Billing Representatives responsible for Hospital Billing (HB) and/or Professional Billing (PB) claims generation, transmittal, and resolution. This role sits between the Billing Representatives and the Billing Supervisor, combining hands-on billing expertise with day-to-day team oversight.

The Billing Team Lead acts as the first point of escalation for billing questions, provides real-time coaching to staff, and helps ensure the team meets quality and productivity expectations. This role also supports the Supervisor in process improvement efforts, team performance monitoring, and compliance with payer guidelines and applicable federal and state regulations.

Key Responsibilities

Team Leadership and Daily Operations

• Demonstrate and uphold Healthrise Core Values in all interactions with team members, clients, and stakeholders
• Serve as the first line of support for Billing Representatives by answering billing questions, troubleshooting claim issues, and escalating complex cases as needed
• Monitor daily team workflows and work queues to ensure timely and accurate processing of claims, rejections, and billing edits
• Review team members’ work for accuracy and compliance and provide real-time coaching and feedback
• Track individual and team productivity and quality metrics and communicate trends or concerns to the Billing Supervisor
• Support onboarding and training of new Billing Representatives
• Promote a collaborative and accountable team environment aligned with Revenue Cycle Operations goals

Billing Operations and Compliance

• Perform daily billing activities alongside the team, including generating and transmitting primary, secondary, and tertiary claims for HB and/or PB accounts
• Resolve billing edits and rejected claims to support accurate and timely claim submission
• Maintain current knowledge of state and federal laws related to insurance contracts, payer billing requirements, and appeals processes
• Apply knowledge of payer rules, contracts, fee schedules, and data sources to ensure claims are billed timely and accurately
• Investigate and address overpayment and underpayment accounts to optimize reimbursement
• Coordinate follow-up with clinical departments, Patient Access, and other stakeholders to resolve claim authorization issues and support appeals
• Ensure all billing actions and resolutions are accurately documented in Epic or an equivalent patient accounting system
• Stay current on CPT, ICD-10-CM, HCPCS, CMS billing guidelines, and payer policy changes that impact claim accuracy

Denial Management and Issue Resolution

• Analyze, categorize, and resolve claim rejections and denials from commercial, government, and managed care payers
• Identify recurring denial trends and payer-specific issues and communicate findings to the Supervisor for escalation and process improvement
• Proactively follow up on payment delays and variances with patients and payers
• Refile accurate claims and document all findings thoroughly
• Request write-offs, transfers, allowances, and reversals as appropriate and in accordance with department policy
• Recommend accounts for transfer to collection vendors based on complexity and account status

Reporting and Process Support

• Prepare and submit reports documenting billing trends, team outcomes, and claim activity for leadership review
• Interpret billing data, draw conclusions, and present findings to the Supervisor to support workflow decisions and improvement initiatives
• Support the rollout and adherence of updated SOPs, job aids, and training materials across the billing team
• Cross-train in various billing functions to improve team flexibility and continuity of service
• Respond to patient and payer inquiries or refer them to the appropriate team member or Supervisor
• Maintain working knowledge of applicable federal, state, and local laws and regulations
• Perform other duties as assigned

Requirements:

• High school diploma or Associate’s degree in Accounting, Business Administration, or a related field, plus at least 3 years of experience in revenue cycle medical billing, insurance follow-up, and/or denial management in a hospital, clinic, insurance company, managed care organization, or similar healthcare financial services setting; or an equivalent combination of education and experience
• Demonstrated experience as a high-performing Billing Representative or equivalent, with readiness to take on a lead or mentoring role
• Proficiency with Epic or an equivalent patient accounting system, including claim editing, work queue navigation, and documentation
• Working knowledge of CPT, ICD-10-CM, and HCPCS coding conventions and their application in hospital and physician billing
• Solid understanding of Medicare, Medicaid, and commercial payer billing requirements, timely filing rules, and claims adjudication processes
• Familiarity with denial management workflows, root cause identification, and appeals processes
• Strong written and verbal communication skills
• Strong organizational and interpersonal skills
• Ability to provide effective peer coaching and real-time feedback in a collaborative team environment
• Strong attention to detail and accuracy
• Ability to manage competing priorities and deadlines
• Proficiency in Microsoft Office, including Outlook, Word, PowerPoint, and Excel
• Comfortable working in a collaborative, shared leadership environment
• Completion of regulatory and mandatory certifications as required
• Experience in a complex, multi-site healthcare environment preferred
• Previous experience working with offshore vendors preferred

Preferred

• Certified Professional Biller (CPB), Certified Medical Reimbursement Specialist (CMRS), Certified Revenue Cycle Specialist (CRCS), or equivalent billing or revenue cycle certification
• Experience supporting or leading training initiatives for billing staff
• Familiarity with automated billing tools, payer portals, or revenue cycle technology platforms
• Experience working in a complex, multi-site or multi-entity healthcare system
• Previous experience with vendors or offshore billing operations management
• Knowledge of the No Surprises Act, price transparency requirements, and other recent regulatory developments affecting hospital billing