Lead Charges and Claims Specialist

This is a fully remote position, open to applicants in Maryland.

📋 Description

• Act as the subject matter expert and lead for the Charges and Claims division.

• Supervise daily operations related to charge and claim submissions.

• Ensure claims are submitted promptly and accurately, adhering to payer guidelines and organizational protocols.

• Address complex billing issues, resolve billing complaints, and respond to inquiries from staff, patients, and insurance companies.

• Evaluate team performance while providing training and support to Charges and Claims Specialists.

• Collaborate closely with providers, practice personnel, and insurance carriers to enhance reimbursement and improve the quality of claims.

• Ensure adherence to regulatory and payer requirements.

• Stay updated on payer requirements, reimbursement policies, and regulatory changes.

• Identify trends affecting claims performance and propose corrective measures.

• Develop and implement process improvements to boost efficiency and minimize claim errors.

• Elevate significant billing or reimbursement issues to the RCM Director.

• Assist in reporting, auditing, and various special projects.

• Engage in revenue cycle meetings and initiatives aimed at process improvement.

• Support departmental objectives related to cash flow, claim acceptance, and reimbursement performance.

⛳️ Requirements

• High school diploma or equivalent is required.

• An associate degree in Healthcare Administration, Business, or a related field is preferred.

• A minimum of 4–5 years of experience in medical billing and claims is necessary.

• A minimum of 1–2 years of experience in leadership, supervisory roles, mentoring, or as a team lead is preferred.

• Strong understanding of medical insurance plans, including commercial, Medicare, Medicaid, and Tricare.

• Advanced knowledge of claim submission, denial management, reimbursement methodologies, and payer policies.

• Familiarity with medical terminology and coding systems such as CPT, HCPCS, and ICD-10.

• Experience with practice management systems, clearinghouses, and EHR platforms.

• Strong analytical skills and problem-solving capabilities.

• Exceptional communication, customer service, and leadership abilities.

• Proficiency in Microsoft Office applications, including Word, Excel, and Outlook.

• Strong written and verbal communication skills, with the ability to interact confidently with patients, providers, insurance representatives, and staff.

• Excellent organizational skills, capable of managing multiple priorities and deadlines.

• Proven ability to lead and nurture a high-performing team.

🏝️ Benefits

• Comprehensive health insurance plans.

• Opportunities for professional development and training.

• Flexible work hours and a supportive work environment.

• Retirement savings plans with company matching.

• Paid time off and holiday benefits.