Lead Billing Specialist

Position Summary The Lead Billing Specialist provides operational oversight and leadership to the Billing Specialist team to ensure accurate, compliant, and timely claim submission for hospital and physician services. This role is responsible for supervising daily workflow, monitoring key billing performance indicators, identifying trends, and implementing process improvements to optimize reimbursement and clean claim rates.

The Team Lead partners closely with Coding, CDI, Patient Access, Denials, Follow-Up, Revenue Integrity, and clinical departments to ensure billing edits and front-end issues are resolved efficiently. This position plays a critical role in training, mentoring, and developing team members while ensuring adherence to payer regulations, compliance standards, and organizational policies.

Attention to detail, data-driven decision-making, strong payer knowledge, and the ability to lead through influence are essential to success in this role. Responsibilities Essential Functions of Role:

Oversees daily pre-bill and post-bill edit resolution to ensure timely claim release.

Monitors workqueues, claim scrubber edits, and billing reports to ensure productivity and quality standards are met.

Ensures claims are submitted within payer timely filing guidelines.

Prioritizes workload to meet departmental KPIs (Clean Claim Rate, DNFB/Pre-AR Days, Initial Denial Rate, Timely Filing).

Reviews billing-related denials to identify trends and implement corrective action plans.

Monitors hardcopy claim processing and supporting documentation requirements.

Escalates payer issues appropriately and partners with leadership to resolve systemic barriers.

Ensures accurate use of UB-04 and CMS-1500 claim forms and required data elements.

Conducts quality audits of team members' work and provides feedback for improvement.

Leads rebill projects and coordinates special initiatives assigned by leadership.

Training, Education & Staff Development:

Assist in developing onboarding training for new Billing Specialists.

Conducts ongoing education related to: CPT, HCPCS, and ICD-10 updates

Payer billing guidelines

Epic or billing system enhancements

Compliance and regulatory updates

Assist in maintaining job aids, workflow guides, and reference materials.

Identifies skill gaps and develops targeted retraining plans.

Coaches team members through performance improvement opportunities.

Promote cross-training to support operational flexibility.

Performance Monitoring & Reporting:

Reviews daily, weekly, and monthly billing indicators and dashboards.

Tracks individual and team productivity, quality, and denial trends.

Reports on the performance metrics to Supervisor/Manager/Director.

Identifies workflow bottlenecks and recommends process redesign.

Collaborates with Revenue Integrity and Coding to reduce preventable edits.

Supports department-wide initiatives to improve first-pass resolution and clean claim rates.

Compliance & Regulatory Accountability:

Ensures adherence to state and federal billing regulations.

Maintains compliance with government and commercial payer billing requirements.

Supports internal audits and compliance reviews.

Promotes ethical billing practices and integrity standards.

Minimum Requirements High School Diploma or equivalent required.

7+ years of electronic billing and/or billing edit experience in hospital and/or physician setting.

1-2 years leadership, senior specialist, or mentoring experience preferred.

Working knowledge of HCPCS, CPT-4, ICD-10, and medical terminology.

Strong understanding of payer requirements and claims processing regulations.

Preferred Certifications:

Certified Revenue Cycle Specialist (CRCS)

Certified Professional Coder- Hospital Services (CPC)

Certified Coding Specialist (CCS)

Certified Revenue Cycle Representative (CRCR)

Epic Resolute preferred

Pay Range $18.74 - $27.32/hr Other Information Remote role (based out of Greenville, NC)

Monday - Friday, full-time (40 hrs/week) day shift

Great Benefits

#LI-REMOTE

#LI-AH2 ECU Health About ECU Health

ECU Health is a mission-driven, 1,708-bed academic health care system serving more than 1.4 million people in 29 eastern North Carolina counties. The not-for-profit system is comprised of 13,000 team members, nine hospitals and a physician group that encompasses over 1,100 academic and community providers practicing in over 180 primary and specialty clinics located in more than 130 locations.

The flagship ECU Health Medical Center, a Level I Trauma Center, and ECU Health Maynard Children¿s Hospital serve as the primary teaching hospitals for the Brody School of Medicine at East Carolina University. ECU Health and the Brody School of Medicine share a combined academic mission to improve the health and well-being of eastern North Carolina through patient care, education and research. General Statement It is the goal of ECU Health and its entities to employ the most qualified individual who best matches the requirements for the vacant position.

Offers of employment are subject to successful completion of all pre-employment screenings, which may include an occupational health screening, criminal record check, education, reference, and licensure verification.

We value diversity and are proud to be an equal opportunity employer. Decisions of employment are made based on business needs, job requirements and applicant¿s qualifications without regard to race, color, religion, gender, national origin, disability status, protected veteran status, genetic information and testing, family and medical leave, sexual orientation, gender identity or expression or any other status protected by law. We prohibit retaliation against individuals who bring forth any complaint, orally or in writing, to the employer, or against any individuals who assist or participate in the investigation of any complaint.