HOSPITAL BILLING LEAD

Job Description

Job Description:\n\n Horizon Health is a Critical Access, Rural Health Facility comprised of 25-inpatient beds located in Paris, IL & a multitude of outpatient clinic settings including Family Practice and Specialty Clinics in Paris and surrounding cities. We have been serving residents of Edgar County since 1968 though community education, emergency services, and outpatient care. As we continue to expand our services & locations, our community has grown far beyond Paris. Our rich history and strong community support pave the way for the future of healthcare as we serve you—our family, friends, and neighbors. Position Summary: The Hospital (HB) Billing Lead serves as the department's senior technical resource, providing day-to-day workflow coordination, technical guidance, and functional leadership for Hospital (HB) Billing operations. Working under the direction of the Central Business Office Supervisor, the Lead supports daily billing activities by coordinating workflow, monitoring claim quality, assisting with staff development, resolving routine operational issues, and serving as the primary technical resource for Hospital (HB) Billing team. While this position does not typically have direct supervisory responsibility, the Lead provides functional leadership through coaching, mentoring, technical expertise, and promotion of departmental best practices. The Hospital (HB) Billing Lead maintains advanced knowledge of Hospital (HB) Billing operations supporting Critical Access Hospital (CAH), Hospital Outpatient (HOP), Emergency Department, Observation, Surgery, Ancillary Services, Hospital-Based (HB) Clinics, Emergency Medical Services (EMS), and other applicable facility service lines. The Lead maintains expertise in facility claim preparation, UB-04 billing, reimbursement methodologies, payer requirements, billing regulations, electronic claim processing, reimbursement policies, and Revenue Cycle best practices while promoting operational consistency, billing accuracy, productivity, customer service, regulatory compliance, and continuous improvement. Serving as the department's subject matter expert, the Lead assists with onboarding, education, workflow improvement, quality monitoring, testing, implementation of operational initiatives, and resolution of complex billing issues. The Hospital (HB) Billing Lead collaborates with Patient Access, Financial Clearance, Coding & Revenue Integrity, Health Information Management (HIM), Finance, Information Technology, clinical departments, and other Revenue Cycle teams to resolve billing issues, improve workflows, reduce reimbursement risk, and promote accurate, timely, and compliant claim submission across all facility service lines. The Lead maintains an understanding of the unique reimbursement and operational requirements associated with Critical Access Hospital (CAH), Hospital Outpatient (HOP), Hospital-Based (HB) Clinics, Emergency Medical Services (EMS), and other applicable care settings to support organizational Revenue Cycle objectives. The Hospital (HB) Billing Lead is expected to model Horizon Health's values through professionalism, accountability, collaboration, technical excellence, integrity, and a commitment to exceptional customer service while fostering operational consistency and supporting the success of both the department and the organization. Essential Functions (Responsibilities/Accountabilities): Leadership at Horizon Health is demonstrated through technical expertise, collaboration, professionalism, and a commitment to helping others succeed. Revenue Cycle Leads are expected to guide the work through subject matter expertise rather than formal supervisory authority. Success is measured through operational excellence, quality, productivity, customer service, collaboration, staff development, and continuous improvement. Leads serve as role models by promoting accountability, teamwork, technical excellence, consistent application of departmental standards, and a positive work environment. Leads influence performance through expertise, mentorship, and collaboration rather than formal authority, serving as trusted resources who support the success of both their teammates and the organization. The responsibilities outlined below represent the core leadership accountabilities of the position and are intended to support consistent operational performance, employee engagement, and achievement of the organization's strategic Revenue Cycle objectives. Department Operations The Hospital (HB) Billing Lead serves as the department's primary technical resource, coordinating daily workflow and providing technical guidance to promote efficient, accurate, and consistent Hospital (HB) Billing operations. Through collaboration, mentoring, and subject matter expertise, the Lead supports staff development, operational excellence, and timely claim processing while assisting department leadership with day-to-day operational priorities. Responsibilities include:Serves as the primary technical resource for Hospital (HB) Billing team by providing day-to-day guidance, workflow coordination, and subject matter expertise. Coordinates daily work activities to support timely, accurate, and compliant billing operations while assisting leadership with workload distribution and workflow priorities. Monitors departmental work queues, claim inventories, billing edits, and operational workflows to identify barriers, prioritize work, and support timely claim submission. Assists staff with resolving complex billing questions, claim issues, payer requirements, reimbursement concerns, and operational challenges. Provides real-time coaching, technical guidance, and workflow support to promote consistent billing practices and operational efficiency. Assists with onboarding, orientation, competency development, and ongoing education of Hospital (HB) Billing team. Promotes standardized workflows, departmental procedures, organizational policies, and Revenue Cycle best practices. Escalates operational concerns, reimbursement risks, system issues, and workflow barriers to department leadership while assisting with development and implementation of solutions. Hospital (HB) Billing Operations Responsibilities The Hospital (HB) Billing Lead serves as the department's subject matter expert for Hospital (HB) Billing operations, providing advanced technical expertise in facility billing, reimbursement methodologies, payer requirements, and claim processing. The Lead supports accurate and compliant billing practices across all facility service lines while promoting reimbursement integrity and continuous operational improvement. Responsibilities include:Serves as the department's subject matter expert for Hospital (HB) Billing operations supporting Critical Access Hospital (CAH), Hospital Outpatient (HOP), Emergency Department, Observation, Surgery, Ancillary Services, Hospital-Based (HB) Clinics, Emergency Medical Services (EMS), and other applicable facility service lines. Provides technical guidance regarding UB-04 claim preparation, facility billing requirements, reimbursement methodologies, payer billing regulations, electronic claim submission, and reimbursement policies. Coordinates and provides technical guidance for the resolution of claim edits, billing exceptions, payer rejections, electronic claim errors, reimbursement issues, and other complex billing scenarios. Researches payer policies, reimbursement regulations, claim processing requirements, billing guidelines, and regulatory updates to support compliant billing practices. Identifies billing trends, recurring claim edits, payer issues, reimbursement risks, and workflow opportunities while recommending operational improvements.Identifies recurring claim edits, reimbursement trends, charging issues, and billing opportunities while collaborating with Coding & Revenue Integrity, Patient Access, clinical departments, and Information Technology to improve charge capture, claim quality, reimbursement accuracy, and overall Revenue Cycle performanceAssists with development, implementation, and maintenance of standardized billing procedures, reference materials, and departmental workflows. Supports accurate charge reconciliation, claim quality, reimbursement integrity, and timely claim submission across all Hospital (HB) Billing operations. Assists with implementation of regulatory changes, payer updates, system enhancements, workflow redesign, and operational improvement initiatives impacting Hospital (HB) Billing. Compliance & Technical Oversight The Hospital (HB) Billing Lead promotes compliance with applicable regulatory requirements, payer guidelines, and organizational policies by supporting billing quality, reimbursement integrity, and standardized operational practices. The Lead assists leadership in identifying compliance risks, educating staff, and implementing corrective actions that strengthen billing accuracy and regulatory compliance. Responsibilities include:Promotes compliance with federal, state, local, payer, and organizational billing regulations, policies, and procedures. Assists with monitoring claim quality, billing accuracy, reimbursement integrity, documentation requirements, and departmental quality standards. Identifies compliance concerns, reimbursement risks, recurring billing issues, and operational trends while communicating findings to leadership. Supports internal audits, quality reviews, payer audits, regulatory reviews, and corrective action initiatives. Promotes accurate application of billing regulations, reimbursement methodologies, payer requirements, and organizational policies. Assists with education related to regulatory updates, payer changes, billing requirements, and compliance initiatives. Cross-Functional Collaboration Effective Revenue Cycle performance depends upon collaboration across departments. The Hospital (HB) Billing Lead partners with clinical departments and Revenue Cycle teams to resolve billing issues, improve workflows, enhance communication, and support organizational initiatives that strengthen financial performance and the patient financial experience. Responsibilities include:Collaborates with Patient Access, Financial Clearance, Coding & Revenue Integrity, Health Information Management (HIM), clinical departments, Finance, Information Technology, and other Revenue Cycle departments to resolve billing issues and improve operational performance. Serves as a departmental resource during implementation of workflow improvements, system enhancements, technology initiatives, and organizational projects. Supports communication between Hospital (HB) Billing and operational departments to improve claim quality, reimbursement accuracy, and Revenue Cycle performance. Participates in multidisciplinary meetings, operational workgroups, educational initiatives, and process improvement activities. Promotes collaboration and positive working relationships throughout the Revenue Cycle and organization. Performance & Accountability The Hospital (HB) Billing Lead supports operational excellence by monitoring workflow performance, identifying trends, recommending improvements, and promoting accountability for quality, productivity, and reimbursement outcomes. Through data analysis and continuous improvement efforts, the Lead helps ensure efficient and effective Hospital (HB) Billing operations. Leadership at Horizon Health is demonstrated through technical expertise, collaboration, professionalism, and a commitment to helping others succeed. Revenue Cycle Leads are expected to guide the work through subject matter expertise rather than formal supervisory authority. Success is measured through operational excellence, quality, productivity, customer service, collaboration, staff development, and continuous improvement. Leads serve as role models by promoting accountability, teamwork, technical excellence, consistent application of departmental standards, and a positive work environment. Leads influence performance through expertise, mentorship, and collaboration rather than formal authority, serving as trusted resources who support the success of both their teammates and the organization. The responsibilities outlined below represent the core leadership accountabilities of the position and are intended to support consistent operational performance, employee engagement, and achievement of the organization's strategic Revenue Cycle objectives. Department Operations The Hospital (HB) Billing Lead serves as the department's primary technical resource, coordinating daily workflow and providing technical guidance to promote efficient, accurate, and consistent Hospital (HB) Billing operations. Through collaboration, mentoring, and subject matter expertise, the Lead supports staff development, operational excellence, and timely claim processing while assisting department leadership with day-to-day operational priorities. Responsibilities include:Serves as the primary technical resource for Hospital (HB) Billing team by providing day-to-day guidance, workflow coordination, and subject matter expertise. Coordinates daily work activities to support timely, accurate, and compliant billing operations while assisting leadership with workload distribution and workflow priorities. Monitors departmental work queues, claim inventories, billing edits, and operational workflows to identify barriers, prioritize work, and support timely claim submission. Assists staff with resolving complex billing questions, claim issues, payer requirements, reimbursement concerns, and operational challenges. Provides real-time coaching, technical guidance, and workflow support to promote consistent billing practices and operational efficiency. Assists with onboarding, orientation, competency development, and ongoing education of Hospital (HB) Billing team. Promotes standardized workflows, departmental procedures, organizational policies, and Revenue Cycle best practices. Escalates operational concerns, reimbursement risks, system issues, and workflow barriers to department leadership while assisting with development and implementation of solutions. Hospital (HB) Billing Operations Responsibilities The Hospital (HB) Billing Lead serves as the department's subject matter expert for Hospital (HB) Billing operations, providing advanced technical expertise in facility billing, reimbursement methodologies, payer requirements, and claim processing. The Lead supports accurate and compliant billing practices across all facility service lines while promoting reimbursement integrity and continuous operational improvement. Responsibilities include:Serves as the department's subject matter expert for Hospital (HB) Billing operations supporting Critical Access Hospital (CAH), Hospital Outpatient (HOP), Emergency Department, Observation, Surgery, Ancillary Services, Hospital-Based (HB) Clinics, Emergency Medical Services (