Lead Medical Billing Specialist - 40 hrs/wk.

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

PURPOSE OF THIS POSITION

The Lead Medical Billing Specialist serves as a subject-matter expert and day-to-day operational resource for facility and professional billing and accounts-receivable activities. The position provides frontline guidance to billing associates, coordinates workflow and coverage, supports complex account resolution, and serves as the first escalation point for technical billing and reimbursement questions. Working in partnership with the Billing Supervisor, the lead supports clean-claim performance, timely follow-up, accurate reimbursement, denial prevention, productivity, quality, and regulatory compliance.

Operational portfolios may include UB-04 facility claims, CMS-1500 professional claims, specific payers, financial classes, and may be reassigned as business needs change without changing the position's core duties, qualifications, or classification.

JOB DUTIES/RESPONSIBILITIES

• Duty 1: Answer first-level associate questions, perform billing and payer research, explain findings, and escalation unresolved or high-risk issues to the Billing Supervisor or appropriate subject-matter resource.
• Duty 2: Maintain working knowledge of UB-04 and CMS-1500 billing processes, including claim edits, coding and modifier impacts, revenue codes, place of service, payer-specific requirements, timely filing, corrected claims, and supporting documentation.
• Duty 3: Review complex, high-dollar, aged, underpaid, rejected, denied, or escalated accounts; research payer guidance and recommend correction, appeal, follow-up, or escalation strategies.
• Duty 4: Coordinate with Revenue Integrity analysts to Identify recurring claim edits, billing defects, eligibility or authorization gaps, documentation issues, denial patterns, payer trends, and reimbursement barriers; summarize findings and recommend corrective action.
• Duty 5: Collaborating with Patient Access, Health Information Services, Denials Management, Coding, Case Management, clinical departments, Information Technology, Contracting, payers, and other stakeholders to resolve account and workflow issues.
• Duty 6: Monitor and coordinate daily work queues, unbilled accounts, claim rejections, denial and follow-up inventories, aging, priority balances, productivity indicators, and supervisor-approved work priorities.
• Duty 7: Communicates workflow expectations and supervisor-approved priorities; identify missed deadlines, performance concerns, compliance risks, material reimbursement exposure, or unresolved barriers and promptly elevate them to the Billing Supervisor.
• Duty 8: Assist the Billing Supervisor with daily staffing coverage, payroll, workload balancing, assignment recommendations, backlog-reduction plans, and identification of capacity constraints or risks to deadlines.
• Duty 9: Coordinate onboarding and training needs with the department's educator/trainer; provide workflow-specific mentoring, side-by-side support, job reinforcement, and feedback on recurring knowledge gaps.
• Duty 10: Support quality reviews, system testing, payer or program implementations, policy and procedure updates, special projects, and workflow-improvement initiatives.
• Duty 11: Maintain an individual billing and follow-up assignment sufficient to remain current in systems, workflows, claim requirements, and payer policies and to support department production needs. Provide overlapping claims coverage.

REQUIRED QUALIFICATIONS

• High school diploma or GED equivalent.
• Two (2)+ years of medical billing, claims, reimbursement, denials management, or healthcare accounts receivable experience. Strong knowledge of billing regulations and claim submission processes.
• Working knowledge of both facility and professional claim workflows, including overlapping claims process. Demonstrate ability to develop cross-functional proficiency within 6 months.
• Demonstrated ability to research payer requirements, interpret billing guidance, resolve complex accounts, and communicate conclusions clearly.
• Demonstrated ability to train, mentor, coordinate work, and influence peers without direct supervisory authority.
• CPFSS certification or obtain within 6 months of hire.
• Knowledge of revenue cycle workflows and systems used within the Revenue Cycle such as Cerner, Trisus, Forvis, Quadax, KaiNexus, 3M, Experian, etc.
• Regulatory compliance and reimbursement of methodologies knowledge required. Ability to research, review, analyze, and interpret Federal, State and Local billing regulations required.
• Ability to compile, analyze and effectively present data and complex information in an informative and meaningful way to a variety of audiences, including leadership.
• Ability to manage complex issues and manage multiple tasks/projects. Excellent organizational and time management skills; detail oriented and follow-through. Self-directed.
• Strong problem-solving, research, and analytical skills.
• Positive service-oriented interpersonal and communication (written and verbal) skills required.
• Ability to effectively present and interact with all levels of the organization, including senior leadership.

PREFERRED QUALIFICATIONS

• Associate's degree in a healthcare related field preferred
• Certified Professional Biller (CPB) certification
• CRCL Certification

PHYSICAL DEMANDS

This position requires a full range of body motion with intermittent walking, lifting, bending, squatting, kneeling, twisting and standing. The associate will be required to walk for up to one hour a day, sit continuously for six hours a day and stand for one hour a day. The individual must be able to lift twenty to fifty pounds and reach work above the shoulders. The individual must have good eye-hand coordination and fine finger dexterity for simple grasping tasks. The individual must have excellent verbal communication skills to perform daily tasks. The associate must have corrected vision and hearing in the normal range. The individual must be able to operate a motor vehicle for business travel and community involvement.