AR Team Lead

Performs day-to-day payment resolution activities within Hospital and/or Medical Group partner revenue operations. Responsible for all post-billed denials, including clinical denials, as part of the Denials Resolution team. Ensures payment is received on denied accounts, identifies root causes of discrepancies, minimizes inappropriate payment delays and variances from expected reimbursement, and resolves or escalates issues. Also serves as first-line support, coach, and quality reviewer for AR Specialists.

Duties and Responsibilities

Denials and Payment Resolution

• Receives, analyzes, and appeals denials; reviews, researches, and resolves payment delays and variances resulting from rejected or denied claims, overpayments, and underpayments.
• Works hospital billing (HB) Medicare denials and underpayments, including applying Medicare rules, edits, and appeal processes to resolve accounts.
• Works California commercial, managed care, and government payor accounts, applying payor-specific rules, contracts, fee schedules, and appeal requirements.
• Processes payments in accordance with contracts and policies to ensure timely and accurate liability resolution.
• Investigates and addresses overpayment and underpayment accounts with the goal of optimizing reimbursement.
• Resolves claims, conducts formal account reviews, identifies lost charge recovery, and analyzes and documents delays and payment variances.
• Proactively follows up on delays and variances with patients and payers, refiles accurate claims, and documents findings.
• Identifies routine issues and resolves or escalates them as appropriate.

Compliance and Knowledge

• Maintains working knowledge of applicable federal, state, and local laws and regulations, including Medicare regulations and California requirements related to contracts, timely payment, and the appeals process.
• Applies knowledge of payer rules, contracts, schedules, and other data sources to resolve payment variances.
• Knows, understands, incorporates, and demonstrates the Healthrise Core Values.

Collaboration and Communication

• Coordinates with clinical departments to support clinical denial appeals.
• Collaborates with Patient Access and other stakeholders to resolve authorization issues.
• Communicates with physicians, office staff, and hospital departments to gather and verify information.
• Responds to patient and payer inquiries or refers them as appropriate.

Reporting and Process 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.
• Requests write-offs, transfers, allowances, and reversals as needed.
• Recommends accounts for transfer to collection vendors based on complexity and status.
• Documents all actions in the patient accounting system.

Team Leadership

• Serves as first line of support for AR Specialists by answering questions, troubleshooting, and escalating complex cases to the Manager.
• Reviews team members’ work for accuracy and compliance, providing coaching and real-time feedback.
• Tracks productivity and quality metrics at the individual and team level and communicates performance trends to leadership.
• Supports onboarding and training of new AR Specialists to ensure consistency in process knowledge and documentation.
• Identifies recurring issues and payer trends and communicates insights upward for process improvement initiatives.
• Cross-trains in various functions to enhance service delivery.
• Continues to build expertise in all aspects of the Denials Resolution Specialist role.
• Performs other duties as assigned.

Requirements

Required

• High school diploma or Associate degree in Accounting, Business Administration, or a related field, with a minimum of two (2) years of revenue cycle experience in a hospital, clinic, insurance company, managed care organization, or similar healthcare financial setting, or an equivalent combination of education and experience.
• Hands-on experience working HB Medicare accounts, including denials, appeals, and payment variance resolution.
• Experience working with California payors (for example, Medi-Cal, California commercial and managed care plans, and delegated medical group/IPA arrangements), including familiarity with their contracts, billing rules, and appeal processes.
• Experience using Epic.
• 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.

Preferred

• Experience in a complex, multi-site environment.
• Previous experience with Global Partner vendors.
• Completion of regulatory/mandatory certifications.
• Prior experience coaching, training, or leading a team.