Lead Charges and Claims Specialist

🔥 0 minutes ago

🦀 Maryland – Remote

🦀 Maryland – Remote

💵 $21 - $31 / hour

⏰ Full Time

🟠 Senior

📋 Claims Specialist

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University of Maryland Faculty Physicians

WebsiteLinkedInAll Job Openings

1001 - 5000 employees

🏥 Healthcare

📚 Education

🧘 Wellness

Healthcare • Education • Wellness

University of Maryland Faculty Physicians is a clinical group practice affiliated with the University of Maryland School of Medicine that provides a wide range of outpatient medical services, including dermatology, cardiology, ophthalmology, urgent care, facial plastic surgery, and medi-spa treatments. The organization operates multiple patient-facing clinics, offers patient portal services (MyChart), appointment scheduling, billing, and partners with the university for clinical education and faculty-led care.

📋 Description

• Serve as the subject matter expert and team lead for the Charges and Claims function • Oversee daily charge and claim activities • Ensure timely and accurate submission of claims in accordance with payer guidelines and organizational standards • Resolve complex billing issues, billing complaints, and questions from staff, patients, and insurance companies • Monitor team performance and provide training and support to Charges and Claims Specialists • Work closely with providers, practice staff, and insurance carriers to optimize reimbursement and improve claim quality • 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 • Participate in revenue cycle meetings and process improvement initiatives • Support departmental goals related to cash flow, claim acceptance, and reimbursement performance

🎯 Requirements

• 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