Medical Billing Team Lead

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

📋 Description

• Guide fellow team members regarding their specific health plans by providing answers to questions and offering direction when necessary.

• Evaluate provider escalations and manage provider resolutions or escalate to management as needed.

• Analyze complex patient accounts to identify issues such as duplicate claims, corrected claims, overpayments, underpayments, and work towards their resolution.

• Perform prompt and accurate follow-ups on professional services claims to ensure all required information has been submitted and claims are being processed using payor portals, secure chat, secure messaging, and telephone calls.

• Detect missing payments from the health plan and assist in researching or locating those payments.

• Assess incoming correspondence from health plans and take appropriate actions or escalate to designated team members as necessary.

• Identify pending claims and determine the next steps required to secure reimbursement for those claims.

• Utilize existing queries to review limited new denials for processing errors, appropriately assign a status based on the review, correct any internal errors, and resubmit claims as needed.

• Follow up with insurance carriers, providers, or other stakeholders to gather additional information or documentation required for claims resolution.

• Monitor incoming messages from providers and respond appropriately or escalate the request to the relevant team member.

• Assist with special claims research projects as assigned.

• Document all interactions and updates in the claims management system.

• Maintain precise records of claim status, actions taken, and resolutions in accordance with established policies and procedures.

• Prepare and submit reports on claim follow-up activities and status updates to management upon request.

• Ensure that all claims follow-up activities adhere to company policies, industry regulations, and legal standards.

• Stay informed about changes in insurance policies, regulations, and industry standards.

• Achieve a quantitative production standard of processing 75 - 125 claims per week.

• Attend departmental and company meetings as required.

• Identify and report trends that could negatively impact claim payments, such as processing errors, denials, or billing issues.

• Investigate and resolve discrepancies or issues related to claims processing and payments.

• Collaborate with other team members and departments to ensure proper claim submission.

• Identify and propose process improvements to enhance the efficiency and effectiveness of the claims follow-up process.

• Engage in training and development opportunities to remain current with best practices and industry trends.

⛳️ Requirements

• At least 5 years of experience as a medical biller or in a similar position.

• Exceptional technical skills, including the ability to operate in multiple systems simultaneously and quickly learn new systems.

• EZ-Cap experience is preferred.

• Experience with Electronic Data Interchange (EDI) Clearinghouse (Office Ally) is preferred.

• Proficiency in Microsoft Suite – Outlook, Teams, Office365, OneNote, OneDrive, SharePoint.

• Familiarity with Sequel Server Management Studio.

• Experience with Confluence and Azure.

• Comprehensive understanding of healthcare benefits, network participation, coordination of benefits, referral and authorization requirements, and insurance follow-up.

• Proficient knowledge of CPT Codes, ICD-10 Codes, Modifiers, MUE, LCD, NCD, and CCI edits.

• Must possess strong time management skills, the capacity to multi-task, resolve problems using critical thinking, and be detail-oriented and highly organized.

• Ability to thrive in a fast-paced environment while maintaining strict confidentiality.

• Excellent written and verbal communication skills.

🏝️ Benefits

• 100% employer-covered medical, vision, dental, and life insurance.

• Paid holidays.

• Sick leave.

• Vacation time.

• 401k retirement plan.

• Additional employee-paid coverage options.