Responsible for leading the Physician and Hospital Billing teams, ensuring timely and accurate claim submissions, resolving complex billing issues, and consistently meeting performance targets. This role supports process improvement initiatives, regulatory compliance, and team development.
Key Responsibilities:
Supervise
Physician Billing (CMS 1500)
and
Hospital Billing (UB-04)
teams (up to 20 agents)
Ensure accurate and timely submission of physician and hospital claims
Monitor and analyze productivity, quality, and AR performance metrics
Review and resolve escalated billing issues, rejections, and denials
Handle complex payer follow-ups for inpatient, outpatient, and professional claims
Ensure compliance with
CMS, HIPAA, and payer-specific guidelines
Collaborate with Coding, Eligibility, Authorization, and QA teams to resolve billing challenges
Identify process gaps and implement corrective and preventive actions
Train, mentor, and evaluate team members to improve performance and engagement
Support audits and ensure documentation accuracy for hospital and physician billing
Requirements:
6+ years of experience
in US Healthcare RCM (Physician & Hospital Billing)
1+ year of experience
in a Team Lead or Supervisory role
Strong knowledge of
CMS 1500 and UB-04 claim forms
Hands-on experience with hospital billing workflows (IP, OP, ER)
In-depth knowledge of payer rules, reimbursements, and denial management
Proficiency with billing software and AR tools
Excellent leadership, analytical, and communication skills
Strong understanding of
CMS regulations and HIPAA compliance
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