AR Resolution Specialist Lead

Key Responsibilities

• Review and resolve complex denied claims requiring appeals, reconsiderations, or payer escalation.
• Prepare and submit detailed appeal packages with supporting documentation including medical records, coding validation, and authorization details.
• Track appeal status, follow up on submissions, and ensure timely resolution.
• Identify appeal trends and recommend process improvements.
• Escalate high-dollar or recurring denial issues to leadership with actionable recommendations.

Account Resolution and Documentation

• Review account history including claim status, remittance details, payer communications, and prior follow-up activity.
• Determine and execute appropriate resolution actions such as corrected claims, resubmissions, adjustments, or transfers.
• Ensure all account activity is documented clearly and accurately in accordance with organizational standards.
• Maintain detailed notes including actions taken, payer responses, and next steps.
• Support team members with complex account research and resolution guidance.

Accounts Receivable Management

• Monitor assigned A/R work queues and prioritize accounts based on aging, payer, dollar value, and timely filing limits.
• Perform timely follow-up on outstanding insurance balances to reduce aging and improve cash collections.
• Track and analyze key A/R metrics including aging, denial rates, and payer turnaround times.
• Conduct audits of accounts including vendor-managed work to ensure quality and compliance.
• Identify barriers to reimbursement and escalate system, payer, or workflow issues.

Denial Resolution

• Analyze claim denials and rejections to determine root causes across the revenue cycle.
• Initiate appropriate resolution actions including corrected claims, reprocessing, reconsiderations, and appeals.
• Identify denial trends related to front-end, coding, billing, or payer processes.
• Collaborate with internal teams and vendors to resolve recurring denial issues.
• Assist in developing strategies to reduce denials and improve first-pass resolution rates.

Leadership and Team Support

• Serve as a subject matter expert and provide guidance to A/R team members.
• Support training and onboarding of new staff and vendor resources.
• Assist leadership in monitoring team performance, productivity, and quality metrics.
• Provide feedback and coaching to improve team performance.
• Reinforce best practices and standard workflows across the team.

Vendor Oversight and Collaboration

• Partner with RCM vendors to ensure alignment with organizational expectations and performance standards.
• Review vendor performance and identify gaps or improvement opportunities.
• Audit vendor-managed accounts to ensure appropriate follow-up and resolution.
• Escalate vendor performance concerns to leadership as needed.

Compliance and Quality Assurance

• Ensure all activities comply with payer guidelines, regulatory requirements, and internal policies.
• Maintain adherence to documentation standards and audit requirements.
• Promote accuracy, accountability, and continuous improvement across workflows.