A Team Leader for US Medical Billing is a critical role that bridges the gap between management and the billers, ensuring the team's operations are efficient, compliant with US regulations (like HIPAA and payer rules), and contribute to a healthy revenue cycle.

Here is a comprehensive job description for a Team Leader, US Medical Billing.

Team Leader, US Medical Billing/Accounts Receivable

Job Summary

The Team Leader, US Medical Billing/AR is responsible for supervising a team of Medical Billing Specialists, ensuring the accurate, timely, and compliant processing of claims and resolution of Accounts Receivable (AR) for US-based healthcare clients. This role serves as the subject matter expert, managing daily workflow, resolving escalated issues, and driving team performance to meet or exceed established Key Performance Indicators (KPIs) and Service Level Agreements (SLAs).

Key Responsibilities

I. Team Leadership & Management (50%)

• Workflow Management: Oversee the daily workflow, assign tasks to team members (e.g., charge entry, claims submission, AR follow-up), monitor work queues, and ensure timely completion to meet production targets.
• Performance Monitoring: Track and report on team and individual performance metrics (KPIs) such as claims denial rate, days in AR, clean claims rate, and collection percentages.
• Coaching & Training: Provide one-on-one coaching, conduct quality audits, and deliver continuous training to team members on US payer-specific rules, new CPT/ICD-10 codes, and billing software updates.
• Mentorship: Motivate, mentor, and develop team members, conducting regular performance reviews and addressing any performance deficiencies or disciplinary issues with management.
• Escalation Point: Serve as the primary point of contact for complex, high-priority, or escalated billing, coding, and AR issues that require expert resolution.

II. Technical & Operational Expertise (40%)

• Subject Matter Expert (SME): Maintain in-depth, expert-level knowledge of the entire US Revenue Cycle Management (RCM) process, from patient registration to final payment.
• Claims Resolution: Proactively research and resolve complex claim denials, rejections, and underpayments, developing effective strategies for appeals and follow-up.
• Compliance: Ensure the team's processes are fully compliant with US healthcare regulations, including HIPAA, HITECH, and specific guidelines for government (Medicare, Medicaid) and commercial payers.
• System Proficiency: Maintain high proficiency in the medical billing software, Electronic Health Records (EHR) systems (e.g., Epic, Cerner), and clearinghouses used by the client.
• Process Improvement: Identify bottlenecks, recurring errors, and denial trends, and propose/implement process improvements to optimize billing efficiency and cash flow.

III. Communication & Reporting (10%)

• Reporting: Prepare and present detailed daily/weekly/monthly productivity and AR reports to senior management, highlighting performance, trends, and mitigation plans.
• Client/Stakeholder Liaison: Communicate effectively with clients, providers, and internal departments (e.g., coding, credentialing, IT) to resolve billing discrepancies and facilitate smooth operations.
• Policy Implementation: Relay updates and implement new billing policies, payer changes, and regulatory requirements across the team.