Billing Project Specialist Team Lead

The Project Specialist Team Lead serves as a subject matter expert within the Revenue Cycle department, supporting the accurate maintenance of payer reimbursement data and claim configuration to ensure proper billing and reimbursement. This role is responsible for maintaining payer allowable amounts, fee schedules, and claim rules while ensuring claims are processed accurately and efficiently.

The Team Lead performs advanced revenue cycle functions and serves as the primary resource for a small team (1–3 team members) by answering questions, assisting with complex issues, and coordinating work priorities. This position acts as the operational lead and escalation point for the team while collaborating closely with the Revenue Cycle Coordinator and Manager.

Responsibilities include:

• Maintaining and updating payer allowable amounts and fee schedules.
• Loading and validating payer reimbursement rates within billing systems.
• Monitoring payer payments and researching payment variances.
• Maintaining claim rules and billing configurations to support clean claim submission.
• Adding vaccine administration codes, BMI codes, and other billing elements as needed.
• Identifying and correcting claim edits or rule issues causing denials or delays.
• Mapping and validating provider credentialing within billing systems.
• Tracking and releasing claims on hold due to credentialing.
• Providing guidance and support to team members on complex issues.
• Assisting with work prioritization and team workflows.
• Escalating system issues or operational barriers.
• Supporting onboarding and training of new team members.
• Identifying opportunities for workflow improvements and assisting with revenue cycle projects.

Education & Experience:

• High school diploma or equivalent required; associate or bachelor’s degree preferred.
• 3+ years of experience in medical billing, revenue cycle operations, or claims processing.

Knowledge & Skills:

• Strong knowledge of healthcare billing practices including CPT, ICD-10, and HCPCS coding.
• Experience with payer contracts, allowable amounts, or fee schedule maintenance.
• Familiarity with insurance credentialing processes and claim lifecycle management.
• Excellent attention to detail and high data accuracy.
• Ability to manage multiple priorities and resolve complex issues independently.
• Strong communication and collaboration skills.

Work Environment:

• Primarily sedentary office position with extended computer work.
• Ability to use standard office equipment and communicate effectively.
• Ability to focus in a fast-paced environment with interruptions.