Billing Lead: Complex Claims & Denials Expert

Blanchard Valley Health System; Findlay (OH); On-site; USD 55,000 - 75,000; Full time

Job summary

Blanchard Valley Health System seeks a Lead Medical Billing Specialist to serve as a subject-matter expert for facility and professional billing and accounts-receivable activities. You will guide staff, coordinate workflows, and support complex account resolution to ensure clean-claim performance and timely reimbursement.

The role involves collaboration across departments, monitoring queues, and driving process improvements while ensuring compliance with billing regulations.

Qualifications

• High school diploma or GED equivalent.
• 2+ years of medical billing, claims, reimbursement, denials management, or healthcare accounts receivable experience.
• Knowledge of facility and professional claim workflows and regulatory requirements.
• Ability to research payer requirements and resolve complex accounts.
• Ability to train, mentor, coordinate work, and influence peers.
• CPFSS certification or obtain within 6 months of hire.
• Experience with Revenue Cycle systems such as Cerner, Trisus, Forvis, Quadax, KaiNexus, 3M, Experian.
• Strong data analysis, reporting, and communication skills.

Responsibilities

• Answer first-level questions and escalate unresolved issues to the Billing Supervisor.
• Maintain knowledge of UB-04 and CMS-1500 processes including edits, coding, and payer requirements.
• Review complex accounts and determine correction or escalation strategies.
• Coordinate with Revenue Integrity to identify recurring defects and reimbursement barriers.
• Collaborate with multiple departments to resolve account and workflow issues.
• Monitor daily work queues, denials, aging, and productivity indicators.
• Communicate workflows and escalate delays or risks to deadlines.
• Assist with staffing coverage, workload balancing, and backlog reduction.
• Coordinate onboarding and training for staff and provide mentoring.
• Support quality reviews, system testing, and policy updates.
• Maintain current assignment and provide overlapping coverage.

Skills

Billing expertise

Denials management

Payer research

Leadership

Training/mentoring

Regulatory compliance

Data analysis

Cross-functional collaboration

Education

High school diploma or GED

Associate's degree in healthcare

Tools

Cerner

Trisus

Forvis

Quadax

KaiNexus

3M

Experian

Job description

Blanchard Valley Health System seeks a Lead Medical Billing Specialist to serve as a subject-matter expert for facility and professional billing and accounts-receivable activities. You will guide staff, coordinate workflows, and support complex account resolution to ensure clean-claim performance and timely reimbursement.

The role involves collaboration across departments, monitoring queues, and driving process improvements while ensuring compliance with billing regulations.