The Billing Team Lead oversees all aspects of the billing process, ensuring timely, accurate claims and strict compliance with payer regulations. This role provides leadership to the billing team, resolves complex issues, monitors key performance indicators, and drives continuous improvement in revenue cycle operations to support optimal reimbursement for services at Circle of Life.

Qualifications:

• High school diploma required; Associate's degree in business, healthcare administration, or related field preferred.
• Minimum of 3–5 years of medical billing experience, including at least one year in hospice billing, preferred; prior leadership experience preferred.
• In-depth understanding of Medicare, Medicaid, and private payer billing rules, including room and board charges, claims submission, authorizations, and appeals.
• Strong analytical, organizational, and communication skills; ability to manage multiple priorities and adapt to evolving regulations and payer policy updates.
• Experience with payment posting, A/R management, refunds, and reconciliation processes.
• Commitment to confidentiality, compliance, and ethical standards (HIPAA); ability to represent Circle of Life to the community professionally and positively.

Duties and Responsibilities:

• Lead, train, and mentor billing specialists to ensure accurate and timely claim submission for all payer types.
• Supervise daily billing operations, including account reconciliation, payment posting, denial management, and appeals processing to ensure accuracy and timely resolution.
• Develop team goals, monitor KPIs (such as days in A/R, claim acceptance rates, money lost list, and collections), and implement strategies to meet targets.
• Ensure proper coding using CPT, HCPCS, and ICD-10 specific to the care provided.
• Review patient records, documentation, and billing data to verify completeness, accuracy, and compliance with all applicable regulations and standards.
• Analyze denied or underpaid claims, oversee research and correction, and manage resubmission or appeals.
• Collaborate with clinical, intake, and administrative teams to verify eligibility and authorization, clarify billing issues, and resolve patient inquiries.
• Prepare performance reports for management and identify opportunities for billing process improvement and staff development.
• Maintain strict compliance with HIPAA, CMS, and payer-specific regulations governing medical billing.
• Perform other duties as assigned.