Lead Billing Specialist, Tier II

POSITION SUMMARY:

The Lead Billing Specialist Tier II oversees daily billing operations and provider enrollment activities, ensuring accurate, efficient, and compliant processes across both functions. This role resolves complex claims and denials—including those related to enrollment or credentialing issues—while maintaining accurate provider information with payers. Serving as a key resource for staff, this role provides training, guidance, and customer support, while addressing inquiries from patients, payers, and internal teams. Additionally, the role monitors performance through reporting, supports enrollment status tracking, and drives improvements that strengthen overall revenue cycle efficiency.

CORE RESPONSIBILITIES:

• Supervise and manage billing: Oversee daily billing activities, ensure processes are efficient, accurate, and follow company policies.
• Enrollment and credentialing coordination: Manage provider enrollment with payers, including completing applications, monitoring status updates, maintaining required documentation, and ensuring timely renewals to prevent reimbursement delays.
• Payer portal management: Maintain and update provider information across payer portals, ensuring accuracy for claims processing and network participation.
• Claim resolution: Handle complex claims, denials, and unpaid balances, including managing appeals related to enrollment or credentialing issues.
• Problem-solving: Investigate and resolve billing questions and problems for staff, patients, and payers, including issues arising from enrollment or credentialing discrepancies.
• Reporting and audit: Prepare and review reports to monitor billing and enrollment performance, track outstanding applications, and identify areas for improvement.
• Customer service: Provide support and communicate with patients and staff regarding billing and enrollment inquiries.
• Training and support: Serve as a resource for other billers and departments, providing guidance and training on billing processes, enrollment requirements, and workflow improvements.

COMPETENCIES:

• Displays willingness to make decisions, resolve conflict and delegate work assignments in a timely manner.
• Adapts to change, takes responsibility for own actions to advance team goals.
• Speaks and writes clearly and persuasively in formal and informal presentations.
• Actively participates in meetings and demonstrates effective listening skills with an open and collaborative mindset.
• Solicits input from appropriate stakeholders, explains reasoning for decisions, and uses strong interpersonal skills to communicate and influence others.
• Gives recognition to others for results.

• Balances team and individual responsibilities while assessing own strengths and weaknesses.
• Exhibits objectivity and openness to others' views.
• Welcomes feedback, build positive team spirit, support all team members.
• Develop alternative solutions, support and share expertise with other team members while building positive morale.
• Demonstrates knowledge of company policies and treats people with respect.
• Works ethically and with integrity, uphold organizational values.
• Keeps commitments, shows respect and sensitivity for cultural differences.
• Educating others on the value of diversity promotes a positive work environment where all feel free to contribute.

• Completes administrative task correctly and on time and develops strategies to achieve organizational goals and values.
• Supports affirmative action and respect diversity, understands organization's strengths and weaknesses, analyzes market and competition, and identifies external threats and opportunities while adapting strategy to changing conditions.
• Prioritizes and plans work activities while understanding business implications of decisions.
• Demonstrates accuracy and thoroughness within approved budget and displays original thinking and creativity.
• Displays knowledge of market and competition that aligns with strategic goals.
• Meets challenges with resourcefulness, generates suggestions for improving work, develops innovative approaches and ideas.
• Displays passion and optimism while exhibiting confidence in self and others.
• Inspires respect and trust while motivating others to perform well and influencing actions and opinions of others.
• Coordinates projects, develops workable implementation plans, includes staff in planning, decision making, and process improvement.
• Communicates and completes changes and progress of projects on time and on budget while managing project team activities to overcome resistance.
• Makes self-available to staff, provides regular performance feedback.
• Develops individual team member skills and encourages growth.

• Promote safety precautions and security measures to ensure the safety of both staff and patients.
• Adheres to data security guidelines, including appropriate use of EMR systems and IT resources.

TYPICAL WORKING CONDITIONS:

• The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job.
• Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

TYPICAL PHYSICAL DEMANDS:

• While performing the duties of this job, the employee is regularly required to use hands for use of a PC as well as other office equipment.
• The employee is frequently required to stand; walk; sit and talk and use hearing to listen.
• The employee is occasionally required to reach with hands and arms and stoop and kneels.
• The employee must occasionally lift and/or move up to 25 pounds.
• Specific vision abilities required by this job include close vision, color vision and ability to adjust focus.
• Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

QUALIFICATIONS:

• CPC or CPB certification preferred.
• Extensive knowledge of provider enrollment processes.
• Experience with payer appeals processes.
• Knowledge of FQHC policies and requirements.
• Exceptional presentation skills.
• Strong analytical skills.

EDUCATION/EXPERIENCE/CERTIFICATIONS/LICENSES:

• Must have a minimum of a high school diploma.
• Associate Degree in Business with emphasis in Accounting/Finance from an accredited college or university in addition to five years of experience; or equivalent combination of education and experience is preferred.
• Prefer knowledge of the EPIC system and relevant third-party liability (TPL) and government websites (e.g., CHAMPS, C-SNAP, Connex, Medicare DDE, Availity, and HMO Medicaid sites used by FHC). Working knowledge of ICD-10, HCPCS, and CPT is also preferred.
• Knowledge of FQHC or RHC billing rules and regulations

Family Health Center has the right to modify the duties and functions of the job description based on the needs of the organization.