Note: The job is a remote job and is open to candidates in USA. Healthrise is a company focused on healthcare revenue operations, and they are seeking an Accounts Receivable Lead to oversee the Denials Resolution team. This role involves managing payment resolution activities, leading a team of AR Specialists, and ensuring accurate and timely payment processing.
Responsibilities
- Knows, understands, incorporates, and demonstrates the Healthrise Core Values
- Serve as the first line of support for AR Specialists, answering questions, troubleshooting issues, and escalating complex cases to the Manager as needed
- Review team members’ work for accuracy and compliance, providing coaching and real-time feedback
- Track productivity and quality metrics at the individual and team level; communicate performance trends to leadership
- Support onboarding and training of new AR Specialists, ensuring consistency in process knowledge and documentation
- Identify recurring issues or payer trends and communicate these insights upward for process improvement initiatives
- 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
- 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
- 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
- Cross-trains in various functions to enhance service delivery
- Continuously learns all aspects of the Denials Resolution Specialist role
- Performs other duties as assigned
Skills
- High school diploma or Associate degree in Accounting, Business Administration, or related field, with a minimum of two (2) years of experience in revenue cycle functions in a hospital, clinic, insurance company, managed care organization, or similar healthcare financial service setting; or an equivalent combination of education and experience
- Demonstrated ability to lead, coach, and support a team of AR Specialists in a fast-paced, production-oriented environment
- Excellent written and verbal communication and organizational skills
- Strong interpersonal and customer service skills
- Attention to detail, accuracy, and time management
- Basic proficiency in Microsoft Office (Outlook, Word, PowerPoint, Excel)
- Comfortable working in a collaborative, shared leadership environment
- Experience using Epic
- Experience in a complex, multi-site environment
- Completion of regulatory/mandatory certifications
- Previous experience with Global Partner vendors
Company Overview