What are the responsibilities and job description for the Lead HC Medical Biller position at Behavioral Health Services Inc?
Job Summary:
The Lead Medical Biller oversees the daily operations of the billing team and supports accurate, compliant, and timely submission of claims across all payer types. This role provides advanced expertise in preparing, processing, reviewing, and reconciling medical bills for private insurance, government programs, and other third-party payers. The Lead Medical Biller monitors claim workflows, performs complex account follow-up, resolves billing discrepancies, and ensures adherence to federal, state, and FQHC-specific billing regulations.
- Responsible for training new hires.
- Assisting management with audits for compliance.
- Assisting management with re-distribution of workloads when needed.
- Representing the staff to contribute input based on proposed changes to policy, workflow, and systems that would impact your team.
- Identifying and reporting any problematic issues related to the duties of your team.
- Assisting in process improvement and quality assurance projects related to your team’s responsibilities.Duties/Responsibilities:
- Reviews and prepares claims to ensure accuracy, completeness, and compliance with payer requirements.
- Verifies billing information, charges, documentation, and insurance coverage prior to submission.
- Submits clean claims and requests additional documentation from internal or external sources as needed.
- Performs timely follow-up on outstanding claims and resolves denials by correcting errors and resubmitting claims.
- Reviews EOBs/ERAs, confirms accurate payment posting, and initiates appeals when claims are underpaid or denied.
- Ensures accurate PPS/FQHC encounter billing, including correct use of qualifying visit codes and sliding fee adjustments.
- Applies knowledge of Medicaid, Medicare, Medi-Cal Managed Care, and other governmental billing regulations.
- Works collaboratively with clinical and administrative departments to resolve billing issues and ensure accurate documentation.
- Communicates with payers and patients professionally regarding claim status and required information.
- Excellent verbal and written communication skills.
- Excellent interpersonal and customer service skills.
- Excellent organizational skills and attention to detail.
- Excellent time management skills with a proven ability to meet deadlines.
- Strong analytical and problem-solving skills.
- Strong supervisory and leadership skills.
- Ability to prioritize tasks and to delegate them when appropriate.
- Ability to function well in a high-paced and at times stressful environment.
- Proficient with Microsoft Office Suite or related software.
- High school diploma or equivalent.
- At least five (5) years of clinical billing experience in health care
- Knowledge of EMR strongly preferred
- CPC certified (ideal but may not be required).
Physical Requirements:
Prolonged periods of sitting at a desk and working on a computer.
Must be able to lift up to 15 pounds at times.
Have full range of motion
Have hand-eye coordination and manual dexterity to operate a keyboard, photocopier, telephone, fax etc.