BILLING TEAM LEAD

Internal Posting Dates June 29, 2026-July 4, 2026

CAH-Patient Finance-Billing Team Lead-Full Time-Day Shift-9383

Pay Range: $26.37-$35.63

Job Summary:

We are seeking a highly skilled and detail-oriented Billing Team Lead to coordinate the billing and reimbursement processes for insurance claims. While remaining a hands-on participant in daily billing operations, the Team Lead serves as a Subject Matter Expert (SME) to provide technical direction and peer coaching to the billing staff. This position coordinates workflow to ensure timely payment and serves as the primary technical liaison between healthcare providers, system clinical and management teams, insurance companies, and the billing department.


Key Responsibilities:


Team Leadership & Workflow Coordination (The "Lead" Elements):

• Workflow Oversight: Monitor team work-queues and assign daily tasks to ensure claims are submitted within deadlines and in accordance with payer guidelines.
• Peer Coaching: Provide side-by-side coaching and technical guidance to team members on complex billing issues, new coding updates, and payer policy changes.
• Quality Review & Direction: Review peer work for accuracy (pre-submission) and provide constructive technical feedback to ensure compliance with company policies.
• Escalation Point: Act as the first point of contact for team members to resolve "stuck" claims, complex medical necessity denials, or difficult payer discrepancies.
• Trend Analysis: Generate and analyze billing reports to identify team-wide denial trends; lead informal "huddles" to discuss solutions and process improvements.
• Audit Coordination: Lead the team's response to insurance payer inquiries, documentation requests, and formal audits.

Direct Billing & Claims Execution (The "Technical" Elements):

• Claim Submission: Process and submit medical claims to insurance carriers (Aetna, Cigna, Blue Cross, United Healthcare, Medicare, Medicaid, Workers' Comp).
• Verification: Review patient records and coding (ICD-10, CPT, HCPCS) to verify accuracy before submission.
• Denial Management: Follow up on unpaid, denied, or rejected claims; work directly with insurance representatives and providers to resolve discrepancies and resubmit.
• Remittance Review: Analyze remittance advice (EOB) to identify underpayments, misapplied adjustments, or issues requiring high-level appeals.
• Payer Communication: Maintain professional communication with insurance representatives to clarify policy details, coverage, and specific billing issues.
• Patient Advocacy: Support team members in explaining insurance coverage, payment responsibilities, and complex billing processes to patients.
• Record Maintenance: Ensure the team maintains detailed, accurate records of all claims, payments, and adjustments within the billing/EMR system.
• Compliance: Stay current with insurance regulations and coding updates to ensure the entire team remains compliant with federal and state laws.

Requirements:

• Experience: 3-5 years of advanced experience in medical billing and claims denial resolution.
• Leadership Ability: Proven ability to provide direction, coaching, and technical support to peers in a collaborative environment.
• Technical Expertise: Advanced proficiency in medical coding (ICD-10, CPT, HCPCS) and deep familiarity with CMS (Medicare/Medicaid) and commercial payer portals.
• Analytical Skills: Strong ability to identify billing errors and analyze reports to improve "clean claim" rates for the team.
• Communication: Excellent verbal and written skills for drafting formal appeals and communicating complex details to providers and patients.
• Organization: Expert time-management skills with the ability to manage personal claim volume while simultaneously coordinating team priorities.
• Systems: High proficiency in electronic medical record (EMR) systems (e.g., Epic, Cerner) and clearinghouse software.

Preferred Qualifications:

• Certification: Certification through AAPC (Certified Professional Biller) or AHIMA (Certified Coding Specialist).
• Contract Knowledge: Familiarity with specific insurance payer contracts, stop-loss provisions, and reimbursement structures.
• Prior Lead Experience: Previous experience in a "Lead," "SME," or similar role within a Union or work-team environment.

Job Type: Full-time (Union/Non-Exempt)