Lead Insurance Billing Representative

Overview:

The Insurance Billing Team Lead is responsible for internal department training of new staff for billing and follow-up functions. Identifies continued education needs to ensure all assigned staff receive necessary training and assists in development of training materials, job aids, or staff meeting presentations. Works with Billing Manager focusing on team and individual performance, productivity and accuracy of billing and follow-up.

This is a Remote position - "NAH reserves the right to make hiring decisions based in part on applicants' state of residence if outside the state of Arizona".

Billing
* Send appropriate claims to audit when needed then generates, insurance claims to clearinghouse and submits claim by paper as appropriate.

* Reviews and make corrections to rejected claims and resubmits to payers.

* Open communication on Updates-CPT codes and ICD-10 codes, as needed. Works with Billing Manager to maximize revenue potential based for services and providers.

 
Claim follow up
* Corrects, edits and manages denied claims through work queues, correspondence and emails: May consist of Invalid CPT, Invalid DX, Missing Modifier, Bill another Carrier, Invalid Eligibility, Authorization/Referral, Documentation Required or Other open tasks requiring intervention.

* Enters encounter notes, regarding rejections and follow up activities performed to enable others to review claim history on all encounters.

* Performs account adjustments or write-offs as needed in accordance with the 'Write-Off' policy.

* Handles internal communications with the health centers related to insurance billing and collections.

* Requests medical records from health centers as requested by the contracted insurance plans.

* Corresponds with and assists vendors involved with patient accounts.

 
Mentoring
* Work with Billing Manager to develop a strategy the team will use to reach its goals.

* Monitoring, organizing, and coaching team on a day-to-day basis.

* Provides training for team members and monitors and determine if additional training is needed.

* Monitors team members' participation and productivity.

* Demonstrates comprehensive knowledge of Revenue Cycle processes and provides recommendations to management for process improvement opportunities.

 
Compliance/Safety
* Responsible for reporting any safety related incident in a timely fashion through the Midas/RDE tool; attends all safety related training programs; performs work in a safe manner; monitors work environment for possible safety issues and ensures others are also performing work in a safe manner.

* Maintains confidentiality of all department, patient, and billing matters.

* Completes all company mandatory modules and required job specific training in the specified time frame.

* Stays current and complies with state and federal regulations/statutes and company policies that impact the employees area of responsibility.

* Maintains an advanced knowledge of yearly billing rules and regs for specific payer groups.

Education
High School Diploma or GED- Required

Associates Degree- Preferred

Certification & Licensures

Experience
3-5 years in medical facility, health insurance, or related- Required

Healthcare is a rapidly changing environment and technology is integrated into almost all aspects of patient care. Computers and other electronic devices are utilized across the organization and throughout each department. Colleagues must have an understanding of computers, and competence in using computers and basic software programs.