Medical Coder and Biller (Team Lead)

About the Role

We are seeking a Medical Coder & Biller - Team Lead to take charge of our billing and coding functions, ensuring accuracy, compliance, and adaptability within the complexities of the American healthcare system. This role requires a leader who understands the intricacies of coding, Medicare, Medicaid, and state-specific regulations while fostering education and mentorship in a collaborative team environment.

This role is not only technical but also strategic. You will guide the team, enhance processes, and empower others to deliver results that align with our mission to improve health equity. The ideal candidate will thrive in navigating the rapidly evolving healthcare landscape while enabling ReKlame Health to scale efficiently.

Key Responsibilities

Billing Operations Management

Lead and oversee all aspects of the billing process, including claims submission, payment processing, and account reconciliation, ensuring accuracy and efficiency.

Ensure accurate, compliant coding with ICD-10, CPT, and HCPCS systems to optimize first-pass claim submissions and maximize revenue for patient care and procedures.

Establish scalable workflows to address multi-state billing complexities, with a focus on state-specific Medicaid requirements and streamlined reimbursements.

Compliance and Adaptability

Monitor and implement changes in Medicare, Medicaid, and other regulatory guidelines, ensuring full compliance across all billing and coding processes.

Conduct regular audits to uphold coding standards, identify gaps, and ensure accurate documentation and billing practices.

Collaboration and Team Leadership

Partner with providers, administrative teams, and payers to address documentation gaps, efficiently resolve coding challenges, and reduce claim denials.

Identify skill gaps and develop tailored training initiatives, such as workshops, coaching sessions, and resource playbooks, to enhance team capabilities.

Subject Matter Expertise and Innovation

Serve as the expert in coding and billing complexities, particularly in navigating multi-state Medicaid and Medicare nuances.

Leverage emerging technologies and automation tools to optimize billing operations, enhance team performance, and support long-term cost efficiency.

You will love this role if:

Certifications: Certified Professional Coder (CPC), Certified Coding Specialist (CCS), or equivalent certification in medical coding.

Experience: Minimum of 3-5 years of professional experience in medical coding and billing, including expertise with Medicare and Medicaid systems.

Strong preference for candidates with experience in behavioral health coding.

Leadership Skills: Demonstrated experience leading and mentoring a team, with a history of improving performance and operational workflows.

Technical Skills: Advanced proficiency with ICD-10, CPT, and HCPCS coding systems and experience with EHR and medical billing software.

Detail-Oriented: Exceptional accuracy and attention to detail in coding/billing and documentation.

Regulatory Knowledge: Strong understanding of HIPAA and healthcare compliance guidelines, with the ability to adapt to changing regulations.

Communication Skills: Exceptional written and verbal communication abilities to effectively collaborate with stakeholders at all levels.

Problem-Solving Expertise: Analytical mindset with the ability to address complex challenges, identify solutions, and implement improvements with speed and accuracy.