LEAD BILLER

  The hospital billing team lead is responsible for prompt and accurate billing and follow-up for all hospital and related professional services provided to patients covered by third party payers, including: Medicare, Medicaid, Blue Cross, Commercial, Workers Compensation and all Managed Care Programs. Responsible to secure timely and accurate reimbursement from third party payers and patients based on appropriate billing and follow up activities. The billing team lead will act as the �go to� individual of their area and ensure a high level of teamwork and efficiency. Will run reports, exhibit a high level of critical thinking and problem solving in order to meet departmental goals. Demonstrates excellent customer service performance in that his/her attitude and actions are at all times consistent with the standards contained in the Vision, Mission and Values of Covenant HealthCare and the commitment to Extraordinary Care for Every Generation.  

Works closely with hospital billing admin, coordinators, and manager, communicating work group and/or payer issues. 
Acts as first line of contact for their team as issues arise with claims, systems, clarification of billing guidelines and/or patient concerns.
 Involve coordinator and/or manager as needed. 
Takes the lead on training and onboarding new team members joining hospital billing. 
Stays current and understands payer updates received via bulletins, websites, newsletters, emails and/or mailings. 
Registers appropriate staff/leaders for training sessions appropriate for new and/or changes made to current billing guidelines or use of payer website.
 Identifies payer issues that may have an impact on the A/R. Communicate these issues with the work group, coordinator, and manager. 
Takes notes during meetings in order to relay back to the team.
 Is to be approachable, teachable, and communicative in a way that is professional to other areas. 
Team Lead is approachable, respected and works well together within their team and both internal and external customers. 
Provides feedback with the Team Leads from the payer groups that impact timeliness on their billing process, working together to resolve workflow issues. 
 Runs reports to resolve high dollar and aging accounts amongst their team. 
 Create and monitor tickets for payer/system issues and work together with coordinator, manager and eCovenant until issues is resolved. 
Coordinator and Manager will support the Team Leads in managing these expectations and ensure timeliness of issues and ticket requests are met. 
Specific Team Lead Work Queues to Monitor and Resolve: 555516 Service Dates Out of Range o 556239 Surgical Log with Outstanding Charges o 556262 IP Room Charge on Account Class of OP o 555919 No Valid Primary Contact o 556796 Quadax - Unmapped Codes o OTHER WQ�s as Needed (Covid, HRSA, etc.) o Assists with Pended Charge Review/Release o Assists with Audit Requests and Record pulls as Needed
Resolves patient billing inquiries and problems, follows up on balances due from insurance companies and patients.
Ability to assist patient/family with questions or concerns about their account as it pertains to payment/reimbursement and setting up payment contracts. 
Performs insurance billing clerical duties including review and verification of patient account information against payer program specifications. 
Enters data electronically to process charges, payments. denials and adjustments. 
Understands the Revenue Cycle. 
Completes and submits claims for payment, electronic or hard copy, including initial billing, all insurance re-billing, and secondary or subsequent billings.
 Responsible for accuracy and third party compliance in all aspects of billing activities in particular in relating to clinical attachments, cpt coding, occurrence, condition and value codes, pre-certification, contractual adjustments or required forms.
Strictly adheres to all rules/regulations and quickly responds to changes, as notified by insurance carriers, employers, third party payers, or government agencies. 
Understands the relationship of timely and thorough claims follow-up to assist in the reduction of days in accounts receivable and payer turn around. 
Maintains a thorough understanding of all HMO, PPO, or managed care contractual relationships and able to determine if correct payments and adjustments were made.
 Ability to identify a credit balance account and make the correct determination as to whom/where the credit balance should be refunded or transferred. 
Reports all repeated errors or omissions of patient insurance and demographic information to the manager. 
Corrects all claims edits or errors promptly and before submission. 
Prioritizes issues and workload effectively. 
Works effectively as both a team member and one on one 
Ability to communicate effectively both verbally and in writing.

EDUCATION/EXPERIENCE REQUIREMENTS:
High School Diploma or equivalent. 
Associates Degree preferred. 
Must have some post HS education, preferably in accounting, information systems or third-party billings. 
Must have a minimum of 18-24 months of relevant work experience or equivalent combination of training and relevant work experience.
 One (1) Year or more of Hospital billing and insurance claim processing experience required. 
One (1) Year or more Insurance and/or account follow-up techniques experience required. 
KNOWLEDGE/SKILLS/ABILITIES 
Strong working knowledge of departmental policies, procedures, and business operations and how they interrelate to other departments in the organization
 Third party billing and collections 
Basic understanding of UB-04, 1500, CPT, HCPC, & ICD-10 Coding. 
Knowledge of hospital and/or medical billing and insurance claim filing.
 Maintains knowledge of Federal, State, and local billing regulations, and informs management and compliance department of discrepancies.
 Insurance and/or account follow-up. 
Knowledge of medical and insurance terminology. 
Minimal typing skills of 35 words/ minute. 
Prefer a strong working knowledge of Excel, Word, PowerPoint 
Must possess clerical skills:10-key, computer, telephone, copier
 Must have good written and oral communication skills 
Must be a team player with the ability to work independently as well as in small or large teams 
Protects and maintains the confidential nature of information 
WORKING CONDITIONS/PHYSICAL DEMANDS
 Ability to maintain regular, punctual attendance consistent with the ADA, FMLA and other federal, state, and local standards. 
Constant hearing 
Frequent lifting up to 25 lbs. 
Frequent standing, walking, sitting, pushing, pulling, twisting, reaching, handling, and talking 
Occasional lifting up to 50 lbs. 
Occasional lifting, carrying, climbing, balancing, stooping, kneeling, crouching, squatting, and feeling.