Lead Medical Biller and Claims Specialist

9 hours ago

Pasay, National Capital Region, Philippines beBeeMedicalBillingSupervisor Full time ₱800,000 - ₱1,200,000
Job Overview

A Medical Billing Supervisor is a leadership role that oversees daily billing and claims operations with a focus on Medicaid claims. This position requires a hands-on leader who can troubleshoot complex billing issues, train staff, and drive the team to meet key performance metrics.

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 senior management 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 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 senior management in preparing for and conducting internal and external audits. Conduct regular quality assurance audits on claims to identify and correct errors before submission.
Qualifications
  • Experience: A 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.
Seniority level

Mid-Senior level

Employment type

Full-time

Job function

Customer Service and Management

Industries

Healthcare Services

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