The Accounts Receivable Lead oversees the day-to-day payment resolution activities of the Denials Resolution team within Hospital and/or Medical Group partner revenue operations. This role carries direct responsibility for post-billed denials, including clinical denials, and ensures the team receives appropriate payment, identifies root causes for discrepancies, and minimizes inappropriate payment delays and variances from expected reimbursement.

In addition to performing core AR resolution work, the AR Lead serves as the first line of support for AR Specialists—answering questions, troubleshooting complex cases, and reviewing team output for accuracy and compliance. This role partners closely with the Manager to coach staff, support onboarding and training, track productivity and quality metrics, and surface payer trends and process improvement opportunities.

The ideal candidate brings strong revenue cycle expertise, sound judgment in resolving complex payment variances, and the leadership presence to guide and develop a team in a fast-paced, production-oriented environment.

Duties and Responsibilities

Team Leadership & Quality Oversight

• Knows, understands, incorporates, and demonstrates the Healthrise Core Values.

• Serve as the first line of support for AR Specialists, answering questions, troubleshooting issues, and escalating complex cases to the Manager as needed.

• Review team members’ work for accuracy and compliance, providing coaching and real-time feedback.

• Track productivity and quality metrics at the individual and team level; communicate performance trends to leadership.

• Support onboarding and training of new AR Specialists, ensuring consistency in process knowledge and documentation.

• Identify recurring issues or payer trends and communicate these insights upward for process improvement initiatives.

Payment Resolution & Denials Management

• Performs daily activities as part of the payment resolution team that receives, analyzes, and appeals denials. Reviews, researches, and resolves payment delays and/or variances resulting from rejected and/or denied claims, overpayments, or underpayments.

• Processes payments as appropriate in accordance with contracts and policies to ensure timely and accurate liability resolution.

• Resolves claims, conducts formal account reviews, identifies lost charge recovery, and analyzes and documents delays and payment variances.

• Identifies routine issues and resolves or escalates them as appropriate.

• Investigates and addresses overpayment and underpayment accounts with the goal of optimizing reimbursement.

• Applies knowledge of payer rules, contracts, schedules, and other data sources to resolve payment variances.

• Proactively follows up on delays and variances with patients and payers, refiles accurate claims, and documents findings.

• Requests write-offs, transfers, allowances, and reversals as needed.

• Recommends accounts for transfer to collection vendors based on complexity and status.

Collaboration & Compliance

• Maintains knowledge of state and federal laws as they relate to contracts and the appeals process.

• Maintains a working knowledge of applicable Federal, State, and local laws/regulations.

• Coordinates follow-up with clinical departments to provide support for appeals.

• Collaborates with Patient Access and other stakeholders to resolve account authorization issues.

• Communicates with physicians, office staff, and hospital departments to gather and verify necessary information.

• Responds to patient and payer inquiries or refers them as needed.

• Documents all actions in the patient accounting system.

Reporting & Continuous Improvement

• Tracks and reports denial types and root causes, recommending process improvements.

• Prepares and submits reports documenting trends, outcomes, and claim activity.

• Interprets data, draws conclusions, and reviews findings with supervisor.

• Cross-trains in various functions to enhance service delivery.

• Continuously learns all aspects of the Denials Resolution Specialist role.

• Performs other duties as assigned.

Qualifications

Required

• High school diploma or Associate degree in Accounting, Business Administration, or related field, with a minimum of two (2) years of experience in revenue cycle functions in a hospital, clinic, insurance company, managed care organization, or similar healthcare financial service setting; or an equivalent combination of education and experience.

• Demonstrated ability to lead, coach, and support a team of AR Specialists in a fast-paced, production-oriented environment.

• Excellent written and verbal communication and organizational skills.

• Strong interpersonal and customer service skills.

• Attention to detail, accuracy, and time management.

• Basic proficiency in Microsoft Office (Outlook, Word, PowerPoint, Excel).

• Comfortable working in a collaborative, shared leadership environment.

• Experience using Epic.

Preferred

• Experience in a complex, multi-site environment.

• Completion of regulatory/mandatory certifications.

• Previous experience with Global Partner vendors.

Physical Demands and Work Environment

• Work Environment: Primarily office or remote-based environment; this role routinely uses standard office equipment such as computers and phones.

• Physical Demands: This is largely a sedentary role; however, employees may need to use keyboards, mouse, and other devices for typing, clicking, and navigating software systems.