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