What are the responsibilities and job description for the AR Resolution Specialist Lead position at Heart Disease Services?
AR Resolution Specialist Lead
Department: Revenue Cycle Operations
Reports To: Revenue Cycle Manager/Revenue Cycle Director
FLSA Status: Non-Exempt
Location: Onsite / Hybrid / Remote
Shift: Day
Hours of Work: M-F
Employment Type: Full Time
Position Summary
The 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 Responsibilities
Appeal Management
- 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
- Participate in internal and external audits as required
- Promote accuracy, accountability, and continuous improvement across workflows
Qualifications
- High School Diploma or equivalent required
- Associate’s or Bachelor’s degree in Healthcare Administration, Business, or related field preferred
- 4–6 years of experience in medical accounts receivable, denial management, or insurance follow-up
- Strong experience with claim follow-up, appeals, and payer communication
- Familiarity with clearinghouses and electronic claim submission processes
- Working knowledge of CMS guidelines and commercial payer policies
- Experience with practice management systems
Performance Accountability / Key Performance Indicators (KPIs)
- Days in A/R
- Denial Rate
- Appeal Success Rate
- First-Pass Resolution Rate
- Timely Follow-Up Rate
- Rework / Correction Rate
- Productivity (Accounts Worked per Day)
Skills & Competencies
- Strong analytical and problem-solving skills with attention to detail
- Ability to interpret EOBs, remittance data, and payer communications
- Solid understanding of revenue cycle workflows and interdependencies
- Ability to manage high-volume workloads and prioritize effectively
- Strong organizational and time management skills
- Effective communication skills for collaboration with internal teams and vendors
- Commitment to accuracy, compliance, and accountability
Working Conditions
- Remote or office-based environment
- Must maintain a workspace that ensures confidentiality and minimal distraction
- Regular use of computer systems and standard office equipment
Physical Requirements
- Prolonged periods of sitting and working on a computer
- Frequent use of hands and fingers for data entry
- Ability to read, analyze, and interpret information on screens and documents
Additional Information
All your information will be kept confidential according to EEO guidelines.