A/R Resolution Specialist LeadThe 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 ResponsibilitiesAppeal ManagementAccount Resolution and DocumentationAccounts Receivable ManagementDenial ResolutionLeadership and Team SupportVendor Oversight and CollaborationCompliance and Quality AssuranceQualificationsHigh School Diploma or equivalent requiredAssociate's or Bachelor's degree in Healthcare Administration, Business, or related field preferred4–6 years of experience in medical accounts receivable, denial management, or insurance follow-upStrong experience with claim follow-up, appeals, and payer communicationFamiliarity with clearinghouses and electronic claim submission processesWorking knowledge of CMS guidelines and commercial payer policiesExperience with practice management systemsPerformance Accountability / Key Performance Indicators (KPIs)Days in A/RDenial RateAppeal Success RateFirst-Pass Resolution RateTimely Follow-Up RateRework / Correction RateProductivity (Accounts Worked per Day)Skills & CompetenciesStrong analytical and problem-solving skills with attention to detailAbility to interpret EOBs, remittance data, and payer communicationsSolid understanding of revenue cycle workflows and interdependenciesAbility to manage high-volume workloads and prioritize effectivelyStrong organizational and time management skillsEffective communication skills for collaboration with internal teams and vendorsCommitment to accuracy, compliance, and accountabilityWorking ConditionsRemote or office-based environmentMust maintain a workspace that ensures confidentiality and minimal distractionRegular use of computer systems and standard office equipmentPhysical RequirementsProlonged periods of sitting and working on a computerFrequent use of hands and fingers for data entryAbility to read, analyze, and interpret information on screens and documentsAll your information will be kept confidential according to EEO guidelines.