Lead Billing Specialist

The Lead Billing Submission Specialist serves as the operational lead and subject matter expert for claim submission activities across multiple programs, payers, and funding sources. This position provides day-to-day workflow coordination, staff support, quality oversight, and training while maintaining an individual billing workload. Responsibilities include claim submission oversight, rejection management, paper EOB administration, ERA conversion efforts, payer issue resolution, and EHR workflow optimization.

The Lead Billing Submission Specialist supports departmental goals by improving clean claim rates, reducing billing delays, and promoting consistent billing practices across the organization. As part of Revenue Cycle succession planning and professional development, this position will eventually cross-train within other Revenue Cycle functions, including Prevention Cycle, AR operations, Revenue Integrity, and Recovery Cycle after demonstrating proficiency in Billing submissions.

• Coordinate daily billing operations and work queues.
• Monitor claim submission performance and billing aging.
  
  Review and resolve claim edits, rejections, and billing exceptions.
• Manage paper EOB receipt, tracking, sorting, and assignment.
• Research payers sending paper EOBs and support ERA enrollment efforts.
• Serve as the first escalation point for complex billing issues.
• Assist with onboarding, training, and quality reviews.
• Support EHR stabilization, billing workflow optimization, and process improvement initiatives.
• Collect, sort and assign paper mail. Manage Revenue cycle email.
• Collaborate with Billing, Prevention Cycle, Recovery Cycle, Revenue Integrity, and Finance support functions.

Minimum Required

Education:

High School Diploma or GED

Preferred Education:

Associate's or Bachelor's Degree in Healthcare Administration, Business Administration, Finance, Accounting, or related field

Minimum

Required Experience:

Three (3) years healthcare billing or revenue cycle experience. Experience working claim submissions, claim edits, and payer follow-up.

Preferred Experience:

Five (5) years healthcare revenue cycle experience. Behavioral Health revenue cycle experience. Experience with ERA, EFT, reconciliation, and payment variance analysis. Experience with AHCCCS, Medicare, Commercial Insurance, PMPM, Case Rate, Tribal, and Grant-funded reimbursement models. Experience training and mentoring staff. EHR conversion or optimization experience.

• Minimum 18 years of age.
• Valid AZ DPS Level I fingerprint clearance card (must maintain valid card throughout employment).

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