Best Practices for Billing Team Leads

As a billing team lead, your primary goals are to maintain efficient workflow processes and eliminate any confusion that hinders these processes. You should focus on mentoring and upskilling your team while ensuring that daily activities are on track to support the departments and, ultimately, help the company achieve its objectives.

Audience

• Team Leads will also serve as subject matter experts in their particular department/area and ensure process adherence, working closely with the Billing Managers to surface day-to-day challenges and suggest modifications to the RCM configuration based on their own experiences and the experiences of their team. 
• Billing Team Leads are responsible for selecting the appropriate treatments for claim creation, ensuring the quality of the data on new and corrected claims before submitting claims for processing on to the payer and supporting your team with admin-level configuration changes.

Steps for claim creation, claim QA, claim submission and admin-level configuration may be performed by the same individual(s) depending on the organization of your team and user permissions/span.

Process Overview

Role	Daily	Weekly
Billing Team Leads	Review Management Center Claim Submission tiles Patients with Claim Corrections Pending Claims Rejected - Pending Review Claims Ready for Review/Submit Resolving and Submitting Corrected Claims Aiding your Billers with configuration changes to generate corrections Reviewing corrected claims in the Submit queue Submitting corrected claims	New Claim Creation and Submission Review Patients with New Claims Pending tile QA unsubmitted treatments Creating claims from submitted treatments Reviewing and Submitting new claims Productivity Ensuring Management Center Claim Submission Tiles are regularly worked to green Weekly Retro of Rejections and Denials Claim Submission Report

Billing Team Leads Daily Tasks

Let's review the Billing Team Lead's daily tasks together!

• As a Lead, begin each day by reviewing the Management Center’s Claim Submission tiles. Focus on the Claims Rejected - Pending Review section. Addressing these rejections is crucial, as it often reveals unknown payer and clearinghouse requirements for successful claim submission. Organize yourself and your team to prioritize troubleshooting these issues, as changes to claim billing processes frequently arise from this review.
  
  
  Each day, your billing team must address the Claims Rejected - Pending Review tile and may need your assistance with administrative changes to effectively create the necessary corrections for resubmitting clean claims.

  Ensure your team thoroughly investigates the details of any claim rejection by following the steps and tips outlined in Best Practices for Billers. Additionally, promptly escalate any rejection types that need administrative-level permissions to you or another Lead.

  Admin-level changes needed can include:

  • Service Billing Profile updates (revenue, bill type, place of service, procedure code, bundling, etc.,)

  • Claim Rules management

  • Claim form or method changes

  • Issue troubleshooting

• Claim corrections are generated after updates are made to incorrect information on a previously submitted claim in response to a rejection or denial. Billers address these corrections on a daily basis and submit them to the Submit queue for Leads to review before final submission.
  
  The Patients With Claim Corrections Pending tile is a count of patients with pending claim corrections.

  • Any claims impacted by a change in the account will be generated by a user or AveaOffice and queued in the Create Corrected Claims sub-tab of the Insurance Claims tab in the Work Center.

  • This tile should be worked to green and display 0 by the end of the day. If a number lingers in this tile, your team may need help with confirming the accuracy of the intended changes.
    

• Submitting corrections promptly and accurately will prevent claim follow-up delays, extend reimbursement times, and help maintain accurate revenue projections for the month.
  
  The Claims Ready For Review/Submit tile is a count of claims currently queued for submission for all practices under your organization’s account. This will include both new and corrected claims.
  
  

  • Any resolved claim corrections are completed by a Biller and queued in the Submit Claims sub-tab of the Insurance Claims tab in the Work Center.

  • As a Lead, you should review the Submit list daily to push claim corrections along quickly. Follow the steps and tips below to expedite the corrections review and submission process.
    

• Step	Action	Helpful Hints
  View Resolved Corrections	Go to Work Center > Insurance Claims > Submit Claims, then select the Practice. or Click on the Claims Ready For Review/Submit tile, then select the Practice.	Sort the list by the Context column to group all Corrections at the top of the list.
  Review/QA the Corrected Claim Data	Read the information displayed in the table for the claim. Click on the View link on each claim line labeled with a context of Correction. Scroll through the list to ensure billing data is accurate.	Use the View link to review a list of all data intended to send to the clearinghouse in the EDI file. No matter the method (electronic or paper), the View list will return the list of claim fields set to go out for the claim. Double-check the updates your billers approved for the correction by clicking on the patient’s name to open a new tab to Insurance Billing > Corrections History. Click the View link on the correction line for a summary of updated fields.
  Submit Corrected Claims	Click the checkmark box next to each claim line with a context of Correction to only select corrected claims. If claims do not need to be mailed in-house with records or appeals letters, then click Submit. If claims need to be mailed in-house with records or appeals letters, then click Print.	Mark as Submitted is a useful tool for preserving a record of a claim change, or a follow-up instance, in the RCM without sending it through the clearinghouse. Aside from in-house mailing, it is also useful for a number of workarounds.
  Confirm Batch Processing	After claim submission, refresh the page until batch details display as Submitted.	If a batch fails or another issue arises, the RCM will display an error and redirect the claims (and you) back to the Submit sub-tab.

Billing Team Leads Weekly Tasks

Let's review the Billing Team Lead's weekly tasks together! 

• As a Lead, you will designate a specific day of the week for your Biller to complete and submit new treatments to billing from the previous week. Review the Management Center’s Claim Submission tiles on claim submission day, paying special attention to the "Patients with New Claims Pending" tile.

  After completing a quality assurance check on all services submitted to billing, you will move those treatments into claim creation. Then, conduct a QA check on the data for the new claims and submit them for processing. Working quickly and diligently during this step—like in all other steps—establishes your organization's claim follow-up and revenue cadence.
  

• Management Center Claim Submission Tiles

  As a Team Lead, the efficiency of your team and their capability to complete daily tasks are essential for the success of your organization. It is crucial to ensure that you and your team consistently achieve daily and weekly goals, as this serves as an indicator of organizational health. Maintaining this focus should be a priority.

  Weekly Retro on Rejections, Denials, and Configuration

  Connecting with your Billers and Billing Manager regularly to review edge-case or recurring rejections, denials, or issues rooted in account or service configuration is a good way to identify areas for improvement in process or account configuration.

  • Consider tracking Time to Bill and Clean Claim Rate as weekly KPIs for your team

  • Review frequency of rejections and corrections week over week to identify trends

  • Discuss recent or needed account configuration changes to regularly achieve KPI goals

  • Identify roadblocks and update team processes

  If your organization uses EOS, a regular L10 meeting with Scorecard tracking can help your team quickly escalate and respond to roadblocks and track toward organizational goals.

  Claim Submission Report

  Utilize the Claim Submission Report on a weekly basis to review new and corrected submissions for the entire organization or specific practices. This report is valuable for providing information on billed charges and services to your billing manager and accounting department, as well as for analyzing various trends.

• Step	Action	Helpful Hints
  QA treatments submitted to billing	Go to Work Center > Insurance Claims > Create New Claims, then select the Practice or Click on the Patients with New Claims Pending tile, then select the Practice	Go to Reporting to run an Unsubmitted Treatments Report for the practice(s) and compare it against a report from the EHR/EMR.
  Prepare treatments for claim creation	Use the Select None/Select All, Toggle link below the patient’s name, or individual checkmark boxes to ensure all appropriate treatments are selected for claim creation.	As an additional QA step, you can use the Eligibility link below each patient’s name to run a quick check for active coverage.
  Create new claims	Click Create New Claims for Selected Treatments button.   You’ll automatically be navigated to the Submit sub-tab once creation is complete.	If an error displays on this screen, move to create claims for treatments by patient or service until the source is identified.
  Review/QA the Claim Data	Read the information displayed in the table for the claims. Click on the View link on claim lines labeled with a context of New, Secondary, or Tertiary. Scroll through the list to ensure billing data is accurate. If a patient billing solution is implemented for the practice, Private Pay or Guarantor billables will display in this list. Use the Show: dropdown to filter the list to only display Insurance claims only.	Sort the list by Created Date to review newest first, or by Payer/Patient to group for review. Use the View link to review a list of all data intended to send to the clearinghouse in the EDI file. The Preview claim form PDF may not include all the data included in the EDI file due to the limitations of image files. No matter the method (electronic or paper), the View list will return the list of claim fields set to go out for the claim.
  Submit New Claims	Use the Select None/Select All links or click the checkmark box next to each claim line with a context of New, Secondary, or Tertiary to only select corrected claims. Click the Submit Claims button
  Confirm Batch Processing	After claim submission, refresh the page until batch details display completely.	If a batch fails or another issue arises, the RCM will display an error and redirect the claims (and you) back to the Submit sub-tab.  Error messages displayed on the claim row are a Lead’s responsibility to address prior to submission. Read each error message carefully and follow the directives given to remove the error. Errors in a claim at the Submit stage will prevent submission.