AR Resolution Specialist Lead

A/R Resolution Specialist Lead

The A/R Resolution Specialist Lead is a senior-level role responsible for leading the resolution of complex insurance accounts receivable while supporting overall team performance and driving timely reimbursement outcomes. This position serves as a subject matter expert in claims follow-up, denial management, appeals, and payer escalation, ensuring that high-risk, aged, and high-dollar accounts are resolved efficiently and accurately. This role requires a deep understanding of the full revenue cycle, including front-end processes (registration, eligibility, authorization), coding, billing, and payer adjudication. The Lead Specialist is responsible for identifying root causes of denials and payment delays, resolving escalated accounts, and translating account-level findings into actionable insights that improve workflows and reduce future revenue leakage. In addition to hands-on account resolution, the Insurance A/R Resolution Specialist Lead plays a critical role in guiding and supporting A/R team members and external vendor partners. This includes providing direction on complex accounts, reinforcing documentation standards, auditing account activity for quality and accuracy, and ensuring adherence to payer guidelines and organizational policies. The Lead Specialist partners closely with leadership to monitor and improve key performance indicators such as A/R aging, denial rates, appeal success rates, and payer turnaround times. This role also contributes to the development and execution of targeted action plans aimed at improving collections, preventing denials, and enhancing overall revenue cycle efficiency. Success in this role requires strong analytical skills, attention to detail, and the ability to manage multiple priorities in a fast-paced environment. The ideal candidate is proactive, solution-oriented, and capable of leading through influence while driving measurable improvements in both individual and team performance.

Key Responsibilities

• Appeal Management
• Account Resolution and Documentation
• Accounts Receivable Management
• Denial Resolution
• Leadership and Team Support
• Vendor Oversight and Collaboration
• Compliance and Quality Assurance

Qualifications

• High School Diploma or equivalent required
• Associate's or Bachelor's degree in Healthcare Administration, Business, or related field preferred
• 4–6 years of experience in medical accounts receivable, denial management, or insurance follow-up
• Strong experience with claim follow-up, appeals, and payer communication
• Familiarity with clearinghouses and electronic claim submission processes
• Working knowledge of CMS guidelines and commercial payer policies
• Experience with practice management systems

Performance Accountability / Key Performance Indicators (KPIs)

• Days in A/R
• Denial Rate
• Appeal Success Rate
• First-Pass Resolution Rate
• Timely Follow-Up Rate
• Rework / Correction Rate
• Productivity (Accounts Worked per Day)

Skills & Competencies

• Strong analytical and problem-solving skills with attention to detail
• Ability to interpret EOBs, remittance data, and payer communications
• Solid understanding of revenue cycle workflows and interdependencies
• Ability to manage high-volume workloads and prioritize effectively
• Strong organizational and time management skills
• Effective communication skills for collaboration with internal teams and vendors
• Commitment to accuracy, compliance, and accountability

Working Conditions

• Remote or office-based environment
• Must maintain a workspace that ensures confidentiality and minimal distraction
• Regular use of computer systems and standard office equipment

Physical Requirements

• Prolonged periods of sitting and working on a computer
• Frequent use of hands and fingers for data entry
• Ability to read, analyze, and interpret information on screens and documents

Additional Information: All your information will be kept confidential according to EEO guidelines.