Job Description

Working as a hands-on subject matter expert and day-to-day team resource, the Team Lead assigns and prioritizes work, monitors held, rejected, suspended, and exception claims, identifies trends affecting reimbursement, coaches team members, and escalates operational barriers and reimbursement risks to management. The role partners across Revenue Integrity, Financial Reconciliation, Billing, Order Management, and other operational teams to strengthen clean-claim outcomes and reduce avoidable rework.

Core Competenciesn bjbjbj

• Frontline Leadership & Coaching — Provides daily work direction, coaching, mentoring, and accountability while supporting team development.

• Revenue Cycle Expertise — Applies healthcare revenue cycle knowledge to claim readiness, billing quality, correction, and submission workflows.

• Clean Claim Management — Drives clean-claim objectives, first-pass acceptance, and accurate, timely claim submission.

• Documentation & Billing Quality — Identifies claim defects, documentation deficiencies, and billing exceptions that may delay reimbursement.

• Queue & Workload Management — Prioritizes work based on aging, financial impact, payer requirements, and operational urgency.

• Analytical Problem Solving — Identifies trends and root causes, resolves day-to-day issues, and recommends practical improvements.

• Process Improvement — Supports workflow redesign and operational improvements that strengthen quality and reimbursement outcomes.

• Collaboration & Communication — Partners effectively across teams while communicating risks, priorities, and escalations clearly.

Essential Duties & Responsibilities

Daily Operations Leadership

• Coordinate daily workflow, queue management, and work distribution activities for assigned Revenue Operations staff.

• Assign and prioritize work based on financial impact, aging, payer requirements, claim status, and operational priorities.

• Monitor held, rejected, suspended, and exception claims, including documentation of deficiencies and billing issues requiring correction.

• Serve as the first point of escalation for day-to-day claim readiness and billing quality questions.

• Escalate significant operational barriers, reimbursement risks, recurring defects, or unresolved issues to management.

Clean Claim Performance

• Drive achievement of clean-claim objectives and billing quality standards across assigned workflows.

• Monitor claim readiness, submission accuracy, and first-pass acceptance performance.

• Identify trends, recurring defects, or process breakdowns negatively affecting reimbursement performance.

• Ensure timely correction and resolution of claim defects, submission issues, and billing exceptions.

• Reinforce consistent application of payer requirements and internal claim-quality standards.

Staff Leadership & Development

• Provide training, coaching, mentoring, and day-to-day work direction to assigned team members.

• Monitor individual and team productivity, quality, aging, and queue-resolution performance.

• Assist with onboarding, competency development, cross-training, and ongoing skill development.

• Support performance management activities through timely feedback and escalation of performance themes to management.

• Promote accountability, collaboration, and consistent execution of team standards.

Process Improvement & Operational Collaboration

• Identify workflow inefficiencies, recurring defects, and root causes affecting claim quality or reimbursement outcomes.

• Develop recommendations to improve quality, timeliness, productivity, and clean-claim performance.

• Participate in process redesign, standard-work, and continuous-improvement initiatives.

• Partner with Revenue Integrity, Financial Reconciliation, Billing, Order Management, Compliance, and other operational teams to resolve claim-readiness issues.

• Support reporting and operational reviews related to clean-claim performance, unbilled aging, billing quality, and queue health.

Success in this role will be measured against the following Key Performance Indicators (KPIs) once performance benchmarks and baseline expectations have been established

• Clean Claim Rate

• First Pass Acceptance Rate

• Unbilled Aging

• Productivity Performance

• Billing Quality Score

• Queue Resolution Timeliness

Experience & Education

• Associate degree required; Bachelor's degree preferred.

• Five (5)+ years of healthcare revenue cycle experience.

• Two (2)+ years of leadership, coordinator, or team lead experience.

• Working knowledge of DME/HME reimbursement and Commercial, Medicare, Workers' Compensation, and Personal Injury claim processes.

• Strong understanding of claim readiness, billing quality, denial prevention, reimbursement workflows, and payer requirements.

• Experience monitoring operational queues, aging, productivity, quality, and claim-resolution performance.

• Strong written and verbal communication skills with the ability to coach, prioritize, influence, and escalate effectively.

• Strong analytical, organizational, and problem-solving skills with exceptional attention to detail.

• Experience leading revenue cycle operations teams preferred.

• Advanced denial-prevention experience preferred.

• Lean, Six Sigma, or other process-improvement training preferred.