Remote Lead Billing Specialist - Claims & Denials Leader

ECU Health; United States; À distance; USD 26 000 - 38 000; Plein temps

Avantages offerts par ce poste

Great Benefits

Remote role (Greenville, NC)

Résumé du poste

ECU Health is seeking a Lead Billing Specialist to oversee the Billing Specialist team and ensure accurate, compliant, and timely claim submission for hospital and physician services. You will supervise daily workflow, monitor KPIs, and drive process improvements to optimize reimbursement and clean claim rates.

The role partners with Coding, CDI, Patient Access, Denials, Follow-Up, Revenue Integrity and clinical departments.

Qualifications

• High School Diploma or equivalent required.
• 7+ years of electronic billing and/or billing edit experience in hospital and/or physician setting.
• 1-2 years leadership, senior specialist, or mentoring experience preferred.
• Working knowledge of HCPCS, CPT-4, ICD-10, and medical terminology.
• Strong understanding of payer requirements and claims processing regulations.

Responsabilités

• Oversees daily pre-bill and post-bill edit resolution to ensure timely claim release.
• Monitors workqueues, claim scrubber edits, and billing reports to ensure productivity and quality standards.
• Ensures claims are submitted within payer timely filing guidelines.
• Prioritizes workload to meet departmental KPIs (Clean Claim Rate, DNFB/Pre-AR Days, Initial Denial Rate, Timely Filing).
• Reviews billing-related denials to identify trends and implement corrective action plans.
• Monitors hardcopy claim processing and supporting documentation requirements.
• Escalates payer issues appropriately and partners with leadership to resolve systemic barriers.
• Ensures accurate use of UB-04 and CMS-1500 claim forms and required data elements.
• Conducts quality audits of team members' work and provides feedback for improvement.
• Leads rebill projects and coordinates special initiatives assigned by leadership.
• Assists in developing onboarding training for new Billing Specialists.
• Conducts ongoing education related to: CPT, HCPCS, and ICD-10 updates
• Payer billing guidelines
• Epic or billing system enhancements
• Compliance and regulatory updates
• Assist in maintaining job aids, workflow guides, and reference materials.
• Identifies skill gaps and develops targeted retraining plans.
• Coaches team members through performance improvement opportunities.
• Promote cross-training to support operational flexibility.

Connaissances

Electronic billing

Billing edits

Leadership

CPT/HCPCS/ICD-10

Medical terminology

Payer requirements

Formation

High School Diploma or equivalent

Outils

Epic Resolute

Description du poste

ECU Health is seeking a Lead Billing Specialist to oversee the Billing Specialist team and ensure accurate, compliant, and timely claim submission for hospital and physician services. You will supervise daily workflow, monitor KPIs, and drive process improvements to optimize reimbursement and clean claim rates.

The role partners with Coding, CDI, Patient Access, Denials, Follow-Up, Revenue Integrity and clinical departments.