Team Leader | DME Billing

Role & responsibilities

Team Management & Delivery

• Lead a team of 812 DME billing associates; manage rostering, shift discipline, and daily huddles.
• Allocate work, monitor queues, track SLAs/KPIs, and drive productivity and quality improvements.
• Conduct coaching, floor support, and monthly performance reviews; manage skill-building and cross-training.

Operational Excellence (DME Billing)

• Oversee eligibility/benefits checks, prior auths, charge entry, claim submission, payment posting (ERA/EOB), AR follow-up, and denials/appeals.
• Ensure adherence to payer-specific rules for DMEPOS: HCPCS Level II, ICD-10-CM, modifiers (e.g., KX, GA, GZ, RR, NU), capped rentals vs. purchase, same/similar checks, and order documentation requirements.
• Review edits/rejections, analyze root causes, and implement corrective actions to improve first-pass yield.

Quality, Compliance & Documentation

• Maintain SOPs/work instructions; enforce HIPAA and client data-security protocols.
• Run audits on samples for accuracy and compliance; publish CAPA where deviations occur.
• Prepare and share daily/weekly MIS: productivity, quality, DSO, denial trends, aging buckets, and recovery.

Stakeholder Communication

• Serve as first point of contact for internal leadership regarding production/quality status, risks, and escalations.
• Coordinate with client POCs on clarifications, payer policy updates, and process enhancements.

Preferred candidate profile

• Advanced Excel for reporting (pivot tables, lookups) and data-driven decision-making.
• Exposure to DME software/EHRs (e.g., Brightree, Kareo, or similar).
• Strong written and verbal communication, with crisp client-facing updates.
• Analytical problem-solving, coaching mindset, and change management capability.

KPIs You Will Own

• Clean-claim rate & first-pass resolution rate
• Denial rate and recovery TAT
• AR aging (030/3160/61–90/90+) & DSO
• Productivity per FTE and audit quality score