Lead Accounts Receivable Claims Specialist

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

📋 Description

• Oversee and manage the daily operations of the Accounts Receivable Claims team.

• Act as the main point of contact for staff concerning denial resolutions, appeals, and specific requirements from payers.

• Keep up-to-date with payer policies and coverage guidelines, and inform team members of any changes.

• Supervise accounts receivable queues to ensure prompt identification and resolution of payment denials.

• Analyze and resolve complicated claim denials, underpayments, and reimbursement issues.

• Detect payment denials through queues and take necessary actions to resolve them.

• Engage professionally with providers to secure documentation or clarification essential for resolving denied claims.

• Re-submit corrected claims as per payer policies or provider instructions.

• Prepare and submit appeals along with supporting documentation to guarantee appropriate claim adjudication.

• Remain informed about appeal processes and requirements for designated payer groups.

• Offer guidance and assistance to team members.

• Track departmental performance and identify trends in denials.

• Collaborate with providers, payers, and leadership to enhance reimbursement and improve revenue cycle performance.

⛳️ Requirements

• High school diploma or equivalent is mandatory.

• An associate degree in Healthcare Administration, Business, or a related field is preferred.

• A minimum of 4–5 years of experience in medical billing, accounts receivable, or denial management is required.

• At least 1–2 years of experience in a leadership, supervisory, mentoring, or team lead role is preferred.

• Extensive knowledge of medical insurance plans, including commercial, Medicare, Medicaid, and Tricare.

• Advanced understanding of claims adjudication, denial management, appeals, and reimbursement strategies.

• Familiarity with medical terminology and CPT/ICD-10 codes.

• Experience with practice management systems and EHR platforms.

• Strong knowledge of medical coding principles and third-party payer operations.

• Exceptional communication and customer service abilities.

• Strong analytical, problem-solving, and critical-thinking skills.

• Proficiency in Microsoft applications, including Word and Excel.

• Excellent written and verbal communication skills.

• Strong organizational skills to manage multiple tasks, priorities, and deadlines.

• Proven ability to work collaboratively as a team player in a medical practice environment.

• Ability to communicate effectively with co-workers through open and honest dialogue.

• Capable of effectively communicating both orally and in writing with internal and external business professionals.

• Must be responsible, reliable, and able to perform job functions with minimal supervision.

• Demonstrated leadership abilities with a capacity to mentor staff and enhance departmental performance.

🏝️ Benefits

• Competitive salary and performance-based incentives.

• Comprehensive health, dental, and vision insurance.

• Retirement savings plan with company match.

• Opportunities for professional development and training.

• Supportive work environment with a focus on teamwork.