Medical Billing Claims Specialist - Lead

Medical Billing Claims Team Lead Company Overview Summit Spine and Joint Centers (SSJC) is a rapidly growing, multi-state Interventional Pain Management practice providing comprehensive clinical, surgical, and imaging services. With locations across Georgia, North Carolina, South Carolina, Tennessee, Florida, and Texas, our team is committed to delivering exceptional, patient-centered care through collaboration, innovation, and clinical excellence. As one of the largest single-specialty pain management practices in the nation, SSJC continues to expand its network while investing in the people who make our success possible. We are seeking motivated, qualified professionals who are passionate about making a meaningful impact and contributing to our continued growth. Job Summary The Medical Billing Claims Team Lead is responsible for supporting the daily operations and performance of the medical billing claims team. This position provides day-to-day guidance to Claims Specialists, assists with training and development, performs quality audits, supports departmental workflow, and serves as the first point of escalation for routine staff questions and concerns. The Team Lead works closely with the Billing Supervisor and upper management to communicate departmental updates, monitor performance, address operational concerns, and ensure claims and month-end responsibilities are completed accurately and within established deadlines. Job Duties & Responsibilities Supervise and coordinate the daily activities of the Medical Billing Claims Specialist team. Provide day-to-day guidance, support, and direction to Claims Specialists. Serve as the first point of escalation for staff regarding general day-to-day duties, workflow questions, and routine operational concerns. Perform audits of claims and batch submissions to ensure accuracy, completeness, and compliance with billing requirements. Assist with training and onboarding of new Claims Specialists. Provide coverage and support to the claims team when staff members are absent or additional departmental support is needed. Communicate departmental updates, expectations, concerns, and performance issues directly to management. Work directly with the Billing Supervisor and upper management to support departmental goals, workflow, and operational needs. Conduct weekly team meetings and communicate relevant updates, expectations, and priorities to staff. Report team updates, concerns, performance trends, and operational issues to management as appropriate. Coordinate and monitor completion of month-end responsibilities and ensure established deadlines are met. Work collaboratively with billing staff and management to maintain productivity, accuracy, and timely claims processing. Audit claims to ensure information is complete and accurate prior to submission. Ensure accurate and timely billing of HCFA 1500 claims. Ensure files are properly documented with appropriate information, including date stamps, logs, signatures, and other required documentation. Create and maintain provider logs for pending medical encounters and encounters requiring corrections. Address billing inquiries from insurance companies, patients, and providers as appropriate. Demonstrate knowledge of CPT, ICD-10, HCPCS coding, and modifiers. Demonstrate knowledge of third-party payers, HMOs, PPOs, Medicare, Medicaid, Workers’ Compensation, Personal Injury, and other insurance plans. Demonstrate knowledge of ERAs and EOBs. Apply knowledge of payer-specific and LCD guidelines. Understand health plan benefits, including deductibles, copays, coinsurance, and eligibility verification. Maintain proficiency with spreadsheets, word processing applications, and Microsoft Office. Work beyond normal scheduled hours when necessary to meet departmental deadlines and business needs. Perform other duties and responsibilities as assigned by management. Qualifications Preferred: Minimum of 3 years of experience as a Lead in medical billing or revenue cycle management within a medical setting. Minimum of 3 years of experience in medical billing or revenue cycle management within a medical setting. Previous experience providing day-to-day leadership, guidance, training, or oversight to billing staff preferred. Experience with Medicare, Medicaid, commercial insurance plans, Workers’ Compensation, and Personal Injury cases. Experience submitting claims for office visits, outpatient procedures, urinary drug screens, DME, MRI, and Chronic Care Management. Strong knowledge of medical billing rules, including coordination of benefits, modifiers, EOBs, and ANSI denial codes. Strong knowledge of CPT and ICD-10 coding and medical pre-certification protocols. Excellent computer skills and familiarity with Microsoft Office. Strong organizational and time-management skills with the ability to monitor multiple deadlines and priorities. Ability to provide effective guidance and feedback to staff and escalate concerns appropriately. Strong communication and interpersonal skills with the ability to work effectively with staff, management, providers, patients, and insurance representatives. Comfortable working in a growing, dynamic organization and navigating change. Self-motivated with the ability to multitask, prioritize work, and perform effectively in a fast-paced team environment. Bachelor’s degree preferred. Experience using eClinicalWorks preferred. Experience in Pain Management preferred. Preferred Location While this is a remote position, preference will be given to candidates residing in one of the following states: Georgia Texas North Carolina South Carolina Florida Candidates located in Georgia should be able to attend meetings or training at our Lawrenceville administrative office as needed. Compensation & Benefits This is a full-time position offering a competitive salary, paid time off (PTO), comprehensive health benefits, and a 401(k) with company match. Essential Job Functions The employee must communicate professionally, respectfully, and effectively with patients, visitors, clinicians, coworkers, vendors, and management, including in busy, demanding, or stressful circumstances. The employee must maintain professional composure and consistently perform assigned duties throughout the scheduled work period. This includes managing routine workplace stressors and feedback without disrupting patient care, patient-facing operations, departmental workflow, or coworkers’ work. The employee must exercise sound judgment, maintain appropriate workplace boundaries, provide and receive routine feedback and direction, appropriately escalate staff and operational concerns, protect confidential patient and business information, and address patient or workplace concerns through established supervisory and safety procedures. The employee must be able to effectively lead and support staff, monitor departmental workflow and deadlines, communicate expectations, identify operational concerns, and assist management in maintaining accurate, timely, and efficient claims operations. The employee may be required to work beyond normal scheduled hours when necessary to meet departmental deadlines and business needs. These functions are essential to the position.