Senior Medical Billing Supervisor - Claims Operations

Summary:

Key Responsibilities:

• Team Supervision and Workflow Management:

• Supervise the day-to-day activities of a team of Medical Billers and Claims Specialists.
• Monitor daily workflow from claim generation to payment posting to ensure tasks are completed accurately and on time.
• Distribute and balance workloads among team members to meet departmental goals and deadlines.

• Performance Monitoring and Reporting:

• Track and report on team performance against key metrics, including clean claim rate, denial rate, and accounts receivable (A/R) aging.
• Identify trends and patterns in billing data to proactively address issues and improve processes.
• Escalate complex or systemic billing issues to the Medical Billing Manager with clear, data-backed recommendations.

• Troubleshooting and Denial Resolution:

• Serve as the primary escalation point for the team on complex or difficult-to-resolve billing issues, particularly with Medicaid claims.
• Assist the team with preparing and submitting high-level appeals for denied claims.
• Liaise with Medicaid payer representatives to resolve disputes and clarify billing guidelines.

• Training and Development:

• Train new billing staff on our specific workflows, software, and compliance procedures.
• Provide ongoing training and coaching to the existing team to ensure they are up-to-date on Medicaid policies and best practices.
• Develop and maintain documentation of billing procedures and workflows.

• Quality and Compliance:

• Ensure all billing practices adhere to HIPAA, Medicaid, and other state and federal regulations.
• Monitor changes in Medicaid policies and communicate them effectively to the billing team.
• Support the manager in preparing for and conducting internal and external audits.
• Conduct regular quality assurance audits on claims to identify and correct errors before submission.

Required Qualifications:

• Experience:

• Minimum of 5+ years of experience in medical billing, with at least 1-2 years in a lead or supervisory role.

• Extensive, hands-on experience with Medicaid claims processing is essential.

• Proven ability to manage and motivate a team to achieve performance targets.

• Technical Skills:

• Advanced proficiency with Electronic Health Record (EHR) and practice management systems.
• Strong analytical skills with a high degree of proficiency in data analysis using tools like Microsoft Excel.

• Certifications:

• A professional billing certification (e.g., AAPC's Certified Professional Biller - CPB) is highly preferred.

• Soft Skills:

• Exceptional leadership, communication, and interpersonal skills.
• Superior attention to detail and a commitment to accuracy.
• Strong problem-solving and critical-thinking abilities.
• Ability to work effectively in a fast-paced environment and manage competing priorities.