Medical Biller Lead

Rewarding career. Competitive salary. Outstanding benefits.

The Medical Biller Lead serves as an advanced revenue cycle resource within Patient Financial Services, supporting the full life cycle of patient accounts from claim creation through final resolution. This position performs complex hospital billing, accounts receivable follow-up, denial resolution, payment posting, reconciliation, refund processing, and related account research while providing day-to-day workflow support to the billing team. The Medical Biller Lead assists with work queue management, staff training, process consistency, and escalation of complex reimbursement issues. This role supports hospital and clinic services in a Critical Access Hospital (CAH) environment and requires strong knowledge of payer requirements, Epic HB workflows, reimbursement, and customer service excellence.

 

STANDARD EXPECTATIONS

• Promotes a Positive Working Environment
  • Conducts oneself in line with organization’s mission, values and standards of behavior.
  • Consistently adheres to organizational policy.
  • Supports and maintains a culture of safety and quality.
  • Participates in committees as assigned.
• Communicates Effectively
  • Builds relationships and works collaboratively with other staff.
  • Provides timely operational updates to supervisor.
  • Responds to communications in a timely manner.
• Performs Duties Efficiently and Effectively
  • Assists in development of department schedule and other assigned staffing needs.
  •  Serves as preceptor for new staff
  • Provides guidance and education for existing staff.
  • Assists in identifying department process improvements. 
  • Provides guidance to others in same position
  • Functions as EHR superuser.
  • Acts in compliance with applicable federal, state, and local regulations.
  • Performs other duties as assigned.

 

DUTIES & RESPONSIBILITIES

Lead Workflow & Team Support

• Act as a day-to-day resource for billing staff, providing guidance on complex accounts, payer requirements, Epic workflows, and reimbursement issues.
• Assist the Sr. Manager of Billing & Reimbursement with prioritization and distribution of work queues, backlogs, special projects, and daily assignments.
• Support onboarding, training, cross-training, and reinforcement of standardized department procedures and workflows.
• Review recurring issues, identify workflow improvement opportunities, and communicate trends or barriers to leadership.

• Provide coverage and operational support across Patient Financial Services as needed.

Patient Interaction and Customer Service

• Serve as a point of contact for escalated patient billing inquiries, providing clear and compassionate communication with patients, payers, and clients.
• Educate patients on financial responsibility, insurance coverage, payment options, financial assistance, and charity care processes.

• Work with patients and payers to resolve coordination of benefits, eligibility, questionnaires, and other issues affecting claim processing or account balances.

Billing & Claims Submission

• Prepare, review, and submit clean hospital and professional claims in compliance with payer requirements.
• Resolve complex claim edits, holds, billing errors, and account issues prior to submission.

• Serve as a resource for complex billing scenarios involving Medicare, Medicaid, commercial payers, and Critical Access Hospital reimbursement.

Accounts Receivable & Payer Follow-Up

• Analyze ERA/EOB information to validate reimbursement, patient responsibility, and payer adjustments.
• Research and resolve payer issues.

• Identify payer trends and escalate significant reimbursement issues to the Sr. Manager of Billing & Reimbursement.

Denials Management & Revenue Protection

• Identify root causes of recurring denials and collaborate with coding, clinical departments, Patient Access, and other teams to prevent recurrence.

• Support denial trending, appeals, recovery efforts, and performance improvement initiatives.

Payment Posting & Cash Application

• Post insurance and patient payments from ERA/EOB, checks, cash, credit cards, and other approved payment sources.
• Apply contractual adjustments, patient responsibility, and other remittance adjustments according to payer documentation and established procedures.
• Ensure payments and adjustments are applied to the correct patient account, encounter, payer, and service line.

• Review posting batches and complex payment activity for accuracy and completeness.

Reconciliation, Refunds & Payment Research

• Reconcile posted payments to remittances, cash receipts, credit card activity, checks, bank deposits, and electronic funds transfers (EFT).
• Research and resolve variances between bank/EFT activity, payment documentation, and amounts posted in Epic.
• Research unidentified, unapplied, misapplied, missing, duplicate, or reversed payments and take appropriate corrective action.
• Review credit balances, recoupments, takebacks, offsets, and refund requests; complete or route refund activity according to department procedures and internal controls.

• Maintain accurate reconciliation and supporting documentation and escalate unresolved discrepancies as appropriate.

Correspondence & Remittance Processing

• Review and process payer and patient financial correspondence related to payments, remittances, refunds, recoupments, denials, and account activity.
• Ensure correspondence is accurately scanned, indexed, documented, and routed to the appropriate account or team member.

• Identify correspondence requiring billing follow-up, medical records, appeals, authorization review, or other action, post and route appropriately.

Epic HB System Responsibilities

• Utilize Epic HB work queues, dashboards, reporting tools, payment posting workflows, and account activity to manage daily billing and A/R workload.
• Monitor assigned work queues and assist with identifying aging, volume, workflow, or system issues requiring intervention.

• Participate in Epic testing, upgrades, workflow development, and optimization related to billing, reimbursement, posting, and reconciliation.

Compliance, Audit & Reimbursement Support

• Ensure billing and payment posting practices comply with CMS, Medicare, Medicaid, payer requirements, HIPAA, hospital policy, and established internal controls.
• Support audits, payer reviews, medical record requests, payment research, and reimbursement analysis by providing accurate account documentation.

• Assist leadership with data gathering, workflow review, and documentation related to reimbursement, accounts receivable, and performance improvement.

 

QUALIFICATIONS

Required

• High school diploma or GED.
• Minimum of 10 years of hospital billing, reimbursement, or progressively responsible healthcare revenue cycle experience.
• Demonstrated advanced knowledge of UB-04 claims, revenue codes, hospital billing workflows, payer follow-up, denials, and accounts receivable.
• Experience with payment posting and reconciliation, including ERA/EOBs, EFTs, checks, cash, credit cards, bank deposits, payer adjustments, recoupments, and refunds.
• Experience researching complex account discrepancies and resolving billing or reimbursement issues independently.
• Strong computer, communication, organization, and time-management skills; knowledge of electronic medical record/billing systems and Microsoft Office Suite.
• Experience billing in a Critical Access Hospital or comparable hospital environment.

• Experience as a lead, trainer, subject-matter resource or workflow coordinator.

Preferred

• Working knowledge of Epic HB strongly preferred.
• Experience billing Medicare and Medicaid hospital claims and working with commercial payer requirements.
• Knowledge of ICD-10, CPT, HCPCS, hospital charging concepts, credit balances, refunds, and denial prevention.

• Associate degree in healthcare administration, business, finance, or related field.

 

WORK ENVIRONMENT AND PHYSICAL DEMANDS

This position is primarily worked in an office environment.  Primarily stationary with occasional standing, walking, lifting, reaching carrying, kneeling, bending, stooping, pushing and pulling of objects weighing up to 20lbs.  The position requires continuous finger dexterity and fine manipulation.

 

The employee must demonstrate the ability to perform the essential functions of the position, with or without reasonable accommodation.

If you are looking for a rewarding career with a great team, you'll enjoy your career with us !

POSITION DETAILS

Hours per week:

40

Employee Status:

Regular Full Time

Shift:

Day Shift (United States of America)

Pay Range:

$29.00 - $50.75

Actual pay offered will vary based on years of experience.

EMPLOYEE BENEFITS

Our benefit package includes medical, dental, vision, life insurance, and retirement options (403(b) & 457). Medical insurance coverage begins on day one and is available to both full time and part time employees. Additionally, employees receive discounts on medical services provided by Whitman Hospital and Medical Clinics. Differentials apply for evening, night, and weekend shifts. Our unique PTO plan enables employees to increase their accrual with each year of service!