AR Team Lead

This is a fully remote position, open to applicants in United States.

📋 Description

• Execute daily payment resolution tasks within Hospital and/or Medical Group partner revenue operations.

• Receive, assess, and appeal denials, including those related to clinical matters.

• Review, investigate, and resolve payment delays and discrepancies from rejected or denied claims, as well as overpayments and underpayments.

• Address hospital billing Medicare denials and underpayments in accordance with Medicare rules, edits, and appeal processes.

• Manage California commercial, managed care, and government payor accounts by utilizing payor-specific rules, contracts, fee schedules, and appeal requirements.

• Process payments in alignment with contracts and policies to ensure timely and accurate liability resolution.

• Examine overpayments and underpayments to maximize reimbursement.

• Resolve claims, perform formal account reviews, identify lost charge recovery, and document delays and payment discrepancies.

• Follow up with patients and payers, refile accurate claims, and document all findings.

• Maintain awareness of relevant federal, state, and local laws and regulations, including Medicare and California-specific requirements.

• Coordinate with clinical departments on appeals for clinical denials.

• Collaborate with Patient Access and various stakeholders to address authorization issues.

• Communicate effectively with physicians, office staff, hospital departments, patients, and payers.

• Track and report on denial types and their root causes; recommend improvements to processes.

• Prepare reports on trends, outcomes, and claims activity; analyze data and discuss findings with the supervisor.

• Request write-offs, transfers, allowances, and reversals; suggest accounts for collection-vendor transfer.

• Document all actions taken in the patient accounting system.

• Act as the first-line support for AR Specialists, troubleshoot issues, and escalate complex cases as needed.

• Review the work of team members for accuracy and compliance; provide coaching and real-time feedback.

• Monitor productivity and quality metrics, communicating performance trends to leadership.

• Assist in the onboarding and training of new AR Specialists.

• Identify recurring issues and payer trends, sharing insights for process enhancements.

• Cross-train in various functions and undertake other assigned responsibilities.

⛳️ Requirements

• High school diploma or Associate degree in Accounting, Business Administration, or a related field.

• At least two (2) years of experience in revenue cycle management within a hospital, clinic, insurance company, managed care organization, or a comparable healthcare financial setting, or an equivalent combination of education and experience.

• Practical experience handling HB Medicare accounts, including denials, appeals, and payment variance resolutions.

• Experience with California payors, such as Medi-Cal, California commercial and managed care plans, and delegated medical group/IPA arrangements.

• Knowledge of California payor contracts, billing regulations, and appeal processes.

• Familiarity with Epic software.

• Exceptional written and verbal communication as well as organizational skills.

• Strong interpersonal and customer service abilities.

• Keen attention to detail, accuracy, and effective 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.

• Preferred: prior experience with Global Partner vendors.

• Preferred: completion of regulatory or mandatory certifications.

• Preferred: previous experience in coaching, training, or leading a team.

🏝️ Benefits

• Fully remote work arrangement.