Accounts Receivable (AR) Lead

Team Leadership & Quality Oversight

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

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

• 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; communicates performance trends to leadership.
• Supports onboarding and training of new AR Specialists, ensuring consistency in process knowledge and documentation.
• Identifies recurring issues or payer trends and communicates 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.