Lead Charges and Claims Specialist (Chesapeake Specialty Care)

The Lead Charges and Claims Specialist serves as the subject matter expert and team lead for the Charges and Claims function. This position is responsible for overseeing daily charge and claim activities, ensuring the timely and accurate submission of claims, resolving complex billing issues, monitoring team performance, and providing training and support to Charges and Claims Specialists. The Lead works closely with providers, practice staff, and insurance carriers to optimize reimbursement, improve claim quality, and maintain compliance with regulatory and payer requirements Essential Functions The Lead Charges and Claims Specialist serves as the subject matter expert and team lead for the Charges and Claims function. This position is responsible for overseeing daily charge and claim activities, ensuring the timely and accurate submission of claims, resolving complex billing issues, monitoring team performance, and providing training and support to Charges and Claims Specialists. The Lead works closely with providers, practice staff, and insurance carriers to optimize reimbursement, improve claim quality, and maintain compliance with regulatory and payer requirements. Maintain current knowledge of payer requirements, reimbursement policies, and regulatory updates. Identify trends impacting claims performance and recommend corrective actions. Develop and implement process improvements to enhance efficiency and reduce claim errors. Escalate significant billing or reimbursement concerns to the RCM Director. Assist with reporting, auditing, and special projects as assigned. Ensure all claims are submitted in accordance with payer guidelines and organizational standards. Participate in revenue cycle meetings and process improvement initiatives. Support departmental goals related to cash flow, claim acceptance, and reimbursement performance. Identify and resolve billing complaints and answer questions from staff, patients, and insurance companies. Education and/or experience High school diploma or equivalent required; Associate degree in Healthcare Administration, Business, or related field preferred. Minimum of 4–5 years of medical billing and claims experience. Minimum of 1–2 years of leadership, supervisory, mentoring, or team lead experience preferred. Strong knowledge of medical insurance plans including commercial, Medicare, Medicaid, and Tricare. Advanced understanding of claim submission, denial management, reimbursement methodologies, and payer policies. Familiarity with medical terminology and CPT, HCPCS, and ICD-10 coding. Experience with practice management systems, clearinghouses, and EHR platforms. Strong analytical and problem-solving abilities. Excellent communication, customer service, and leadership skills. Familiarity with Microsoft Office applications, including Word, Excel, and Outlook. Strong written and verbal communication skills, including the ability to confidently communicate with patients, providers, insurance representatives, and staff. Excellent organizational skills with the ability to manage multiple priorities and deadlines. Demonstrated ability to lead and develop a high-performing team. Total Rewards The referenced base salary range represents the low and high end of Chesapeake Specialty Care salary range for this position. Some candidates will not be eligible for the upper end of the salary range. Exact salary will ultimately depend on multiple factors, which may include the successful candidate's geographic location, skills, work experience, market conditions, internal equity, responsibility factor and span of control, education/training and other qualifications.