Summary

This person will assist the Billing Manager and support the management of billing and collections processes for our

outpatient pediatric therapy practice. The role requires strong leadership skills, a comprehensive understanding of

medical billing and coding, and a commitment to ensuring accurate and timely claim submissions as well as

effective revenue cycle management.

Essential Duties and Responsibilities

The Billing Team Lead ensures the completion of delegated billing and collections tasks efficiently and accurately,

including:

Team Leadership:

Supervise and manage team tasks to maintain efficient workflow.

Provide training, support, and mentorship for team members.

Monitor team performance to identify and address areas for improvement.

Eligibility, Billing, and Coding:

Conduct insurance eligibility verifications for clients before services are rendered.

Ensure accurate and timely coding of medical services using CPT, ICD-10, and HCPCS codes.

Explanation of Benefits (EOB) Posting into EHR system

o Input Manual checks

o Download and post manual checks

o Review all postings to ensure accurate allocations

Research denied claims and partial payments

Claim submissions

Making outbound calls to insurance companies, patients and physician offices

Stay current on billing and coding regulations and guidelines.

Identify and resolve coding and billing errors.

Claims Submission and Follow-up:

Ensure the timely submission of clean claims to insurance payers.

Monitor claim statuses and initiate follow-up on denials or rejections.

Accurately record Explanation of Benefits (EOB) details in the electronic healthcare record (EHR) system.

Appeal denied claims as necessary to maximize reimbursement.

Collaborate with insurance payers to resolve billing issues.

Revenue Cycle Management:

Report on assigned key performance indicators (KPIs) to identify trends and opportunities for improvement.

Collaborate with internal operations (front desk and clinical staff) to ensure accurate and complete patient

information.

Develop and maintain strong relationships with insurance payers.

Compliance and Regulatory:

Ensure compliance with HIPAA regulations and other relevant healthcare laws.

Stay informed of healthcare regulations changes and implement necessary updates.

Maintain accurate and organized records.

Coordinates and follows up with clinical and office staff to assist in billing matters

Accurately documents and maintains client files in company EHR and payer online systems

Any other tasks delegated by the Billing Manager after provided with the proper training

Skills and Qualifications

Education: High school diploma or equivalent.

Experience: Minimum of 5 years in medical billing and coding.

Knowledge of NC Medicaid and Managed Care: Familiarity with NC Medicaid, Medicaid Managed Care, and

Tailored Health plans, including reimbursement guidelines.

Strong leadership, organizational, and analytical skills.

Effective communication, interpersonal, and problem-solving skills.

Proficient in medical billing software and electronic health records (EHR) systems.

High attention to detail and accuracy with the ability to prioritize tasks.

Ability to work independently and as part of a team.

High degree of professionalism, accountability, and ownership.

Possess a willingness to learn, develop new skills, and the adaptability to adjust to change.

Goal-driven with a strong focus on reaching targets.

Creativity and relationship-building abilities.

Reliable attendance and punctuality.

Ability to thrive in a fast-paced, team-oriented environment.

A passion for working with the pediatric population and their families.