Team Lead - AR ( RCM // US Healthcare )

Role & responsibilities

1. Team Leadership and Management:

• Lead, supervise, and motivate the accounts receivable team to meet goals and ensure high levels of performance and customer service.
• Monitor individual and team performance, provide constructive feedback, and ensure that all tasks are completed efficiently and accurately.
• Provide training and development opportunities for team members to enhance skills in AR management and healthcare billing processes.
• Organize and prioritize the teams workload to ensure daily, weekly, and monthly deadlines are met.
• Perform performance reviews, set KPIs, and implement strategies for continuous improvement within the team.

2. Accounts Receivable Operations:

• Oversee the end-to-end process of accounts receivable, including claim submission, follow-up on unpaid claims, payment posting, and denial management.
• Ensure accurate and timely submission of claims to government payers (Medicare, Medicaid) and commercial insurance carriers.
• Monitor aging reports, analyze trends, and ensure effective follow-up on overdue accounts.

o Resolve complex issues related to claim rejections, denials, and underpayments, ensuring claims are resubmitted or appealed appropriately.

• Ensure accurate cash application and proper posting of payments received.

3. Compliance and Billing Guidelines:

• Ensure all accounts receivable processes comply with HIPAA, healthcare regulations, payer-specific rules, and internal policies.

Stay up to date with changes in payer guidelines, insurance policies, and

government regulations affecting billing and collections.

• Implement corrective actions if team members deviate from standard operating

procedures and ensure full compliance.

4. Denial and Dispute Management:

• Review and analyze denied claims to identify trends and root causes.
• Develop strategies to resolve denials quickly and reduce the rate of claim denials.
• Lead the efforts for timely follow-up and appeals processes to minimize outstanding AR.
• Work collaboratively with the billing team to ensure all claims are accurate before submission.

5. Reporting and Performance Analytics:

• Prepare and present weekly, monthly, and quarterly AR aging reports to management.
• Provide insights and recommendations on ways to improve cash flow, reduce outstanding receivables, and optimize revenue cycle performance.
• Analyze AR data to identify bottlenecks, inefficiencies, or opportunities for process improvement.

6. Collaboration and Cross-Department Coordination:

• Act as the liaison between the accounts receivable team and other departments, including billing, coding, and finance, to resolve complex issues.
• Work closely with the operations team to align on best practices and ensure smooth revenue cycle processes.
• Assist in the development of policies and procedures to streamline AR operations and improve collection performance.

7. Training and Process Improvement:

• Provide ongoing training for new hires and current team members on AR procedures, payer requirements, and system updates.
• Continuously evaluate and recommend improvements to AR processes, software systems, and team efficiency.
• Ensure that the team remains updated on industry changes, payer updates, and other relevant developments.

Customer Service and Patient Interaction:

• Address escalated patient or payer concerns and ensure issues are resolved professionally and promptly.
• Maintain a strong focus on customer service, ensuring that patient billing issues are handled effectively and professionally.