Billing Follow Up Rep Lead – Durable Medical Equipment ( DME )

• Responsible for daily claims submissions to the appropriate payer source. Communicates with internal and external parties to resolve charging issues affecting the claims. Reports trends with other departments that may improve the claims submission process.
• May be responsible for collection of an assigned section of the insurance receivables, following all procedures and guidelines established.
• Reviews assigned accounts and takes appropriate course of action: internal or external problems that may cause a delay in reimbursement.
• Responds to telephone or written correspondence from internal and external parties regarding insurance claims. Applies contractual allowances where necessary.
• Assists team with more complex issues to resolve problems, provides necessary training, and provides ongoing feedback on performance.
• Monitors and audits productivity, quality and analyzes daily statistics looking for any trends which are reported to management. May provide feedback to Billing Rep I and II.
• Attends and participates in meetings as required, attend outside seminars and be used as “train the trainer” . Share training knowledge with others as appropriate.
• Keeps abreast with insurance payor updates/changes and assists management with recommendations for implementation.
• Prioritize rejections to avoid timely filing insurance appeal  limitations, may include denials.
• Accountable to assess and resolve advanced projects as assigned. Research/Distribute new upgrades/information from the Insurance Payers re: Contracts, guidelines, reimbursement rules and regulations and for computer systems.

• Years of Experience:  Typically requires 5 years of related experience in medical/billing reimbursement environment, or equivalent combination of education and experience.
• Level of Education:  High School Diploma or General Education Degree (GED)

• Proficient in all follow up rep functions.
• Demonstrated ability to work and solve billing / follow up issues in a healthcare environment.
• Broad and comprehensive knowledge and understanding of department-specific procedures.
• Strong analytic, organization, communication (written and verbal), and interpersonal skills.
• Ability to successfully lead, coach, and train a team, and problem solve complex accounts.
• Knowledge of medical terminology, coding terminology (CPT,ICD- 10,HCPC), and insurance/reimbursement practice.
• Able to use Zoom, Microsoft office, or other communication software for meetings.

This job description indicates the general nature and level of work expected of the incumbent. It is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities required of the incumbent. Incumbent may be required to perform other related duties.