Lead Billing Specialist-Fresh Start Medicine

 Key Responsibilities:

· Oversee the billing department’s billing team, providing leadership and ongoing oversight.

· Delegate assigned claims loads among the billing department staff efficiently and productively.

· Audit, correct, and submit the end-of-day claims batches on a daily basis. Provide positive and constructive feedback to billers on their work.

· Accurately review and generate claims, ensuring adherence to coding standards, payer guidelines, and regulatory requirements.

· Maintain a reasonably current claims-load; communicating any challenges and/or issues as they arise to avoid unnecessary delays and avoidable denials.

· Ensure billers are cross trained on billing all service lines, where possible. Provide ongoing training, leadership, and support to billers; fills in where needed when staff are out or off, assuring billing stays current and backlogs are minimized.

· Verify patient insurance information, eligibility, and benefits to facilitate timely and accurate claim submissions, as needed.

· Resolve billing discrepancies and denials by identifying, investigating, and addressing issues related to coding errors, missing information, or other billing inaccuracies. Keeping Chief Operating Officer informed of any identified trends, recurring issues, global denials on an ongoing basis and relaying such information to the team for improved outcomes.

· Collaborate with internal and external teams to obtain necessary documentation for claim processing and resolve billing-related inquiries.

· Stay informed on changes in coding regulations, payer policies, and industry standards to ensure compliance and efficient claim submissions.

· Stay informed on policy changes, NCCI edits, and coding and billing guidelines that directly or indirectly impact the processing of claims; reporting updates to RCM as changes are identified.

· Knowledge of Medicare, Medicaid, and private payor insurance guidelines and payment methodologies.

· Utilize InSync’s reports, dashboards, and tools to analyze and track billing data, claims productivity, and monitor the revenue cycle from claim generation to claim payment, improving processes where needed.

· Provide support in auditing and quality assurance processes to ensure billing accuracy and data integrity.

· Ongoing communication and collaboration with RCM Team and internal stakeholders.

· Participate in ongoing training and professional development to stay current with industry best practices and enhance job performance. Attend relevant webinars held by payers, plans, states.

· Assist with relevant projects and assignments, as needed.

Qualifications:

· High school diploma or equivalent; additional education in medical billing, coding, or healthcare administration is a plus.

· Minimum of 2 years of experience in healthcare, administrative, clerical, or IT setting preferred.

· Proficiency in CPT and ICD-10 coding, with a strong understanding of outpatient billing procedures a plus.

· Familiarity with insurance verification processes and claim submission requirements for various payers.

· Knowledge and understanding of the complexities of behavioral health billing a plus.

· Excellent attention to detail, organizational and note taking skills, and ability to efficiently prioritize tasks.

· Strong communication skills to interact effectively with management, payors, patients, and internal teams.

· Strong computer knowledge and some proficiency in Microsoft applications (Excel a plus)

· Familiarity with provider and insurance verification portals and websites or ability to learn.

· Commitment to maintaining patient confidentiality and upholding ethical standards in billing practices.         

Benefits include Medical, Dental, Vision and PTO.