Billing Team Lead
Healthrise, Farmington Hills, MI, United States
Description
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.
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
#J-18808-Ljbffr
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.
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
#J-18808-Ljbffr