AR TEAM LEAD

The Accounts Receivable (AR) Team Lead at Riverside Healthcare plays a pivotal role in overseeing all billing and collection activities related to insurance accounts receivable. This position, under indirect supervision, is responsible for the coordination, training, and mentoring of the AR team members, ensuring accurate and timely processing of insurance claims and follow-ups. The AR Team Lead acts as a key resource for all departments within the health system, offering expertise in contracted insurance payers, coding, and fostering a collaborative team environment. This role also emphasizes adherence to patient satisfaction principles and requires the ability to perform additional tasks as assigned and demonstrates flexibility with assignments within professional scope/duties/licensure.

Essential Duties

• Team Leadership & Training: Lead, train, and mentor the AR team, ensuring all members are equipped with the necessary skills and knowledge to perform their duties effectively.
• Billing & Collections: Oversee all billing and collection activities related to insurance accounts receivable, ensuring accuracy and compliance with established procedures.
• Claims Management: Handle complex insurance denials, perform root cause analysis, and implement corrective actions to reduce and prevent future denials. Engage in appeals processes to secure payment resolution.
• Process Improvement: Identify and recommend opportunities for improving customer service, system processes, and overall efficiency. Partner with management to implement necessary changes.
• Compliance & Standards: Ensure adherence to HIPAA privacy standards and compliance with patient health information privacy practices in all communications. Maintain an understanding of evolving payer classifications and reimbursement policies.
• Coding & Documentation: Review and resolve coding-related denials, correcting CPT, ICD-10, and HCPCS codes as needed. Maintain coding compliance and stay updated with recognized coding guidelines and billing requirements.
• Collaboration: Actively participate in payer calls, provide feedback to payer representatives, and escalate issues as necessary. Keep the manager informed of progress, achievements, and any issues that arise.
• Productivity & Quality: Run staff productivity, perform monthly audits, and provide feedback to staff. 
• Special Projects: Assist with special projects and other duties as assigned, as necessary.
• Continuing Education: Participate in trainings and seminars as assigned by the Patient Accounting Manager to stay current with industry standards and improve job performance.

Non-essential Duties

• Assist with other administrative duties or tasks as assigned by management.
• Support cross-functional teams as needed for comprehensive billing and collection processes.

Required Experience

• Completion of ICD-10 and CPT coding courses from AAPC or AHIMA is required
• 2-3 years of experience in collections, claims follow-up, or denials required.

Preferred Experience

• Experience in a physicians office or other healthcare setting preferred.
• Knowledge of insurance and authorization processes is helpful.
• Previous experience with EPIC is preferred.
• Understanding of the hospital or physician revenue cycle is preferred.

Required Licensure/Education

• High School Diploma or equivalent required.  
• Certified Coder required or must obtain within 6 months of hire.

Preferred Education

• Strong analytical and problem-solving skills.
• Excellent communication and interpersonal skills.
• Ability to work independently and as part of a team.
• Proficiency in maintaining confidentiality and adhering to privacy regulations.

This job description indicates the general nature and level of work expected of the incumbent. It is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities required of the incumbent. Incumbent may be required to perform other related duties.

Our Commitment to You:

Riverside Healthcare offers a comprehensive suite of Total Rewards: benefits and nationally rated employee well-being programs, competitive compensation, generous retirement offerings, programs that invest in your career development and so much more so your journey at and away from work is remarkable. Our Total Rewards package includes: 

Compensation

•              Base compensation within the positions pay range based on factors such as qualifications, skills, relevant experience, and/or training
•              Premium pay such as shift differential, on-call
•              Opportunity for annual increases based on performance

Benefits - .5 to 1.0 FTE

•              Paid Time Off programs
•              Health and welfare benefits such as medical, dental, vision, life, and Short- and Long-Term Disability
•              Health Savings and Flexible Spending Accounts for eligible health care and dependent care expenses
•              Defined contribution retirement plans with employer match and other financial wellness programs
•              Educational Assistance Program

Benefits - .001 to .49 FTE:

•              Paid Leave Hours accrued as you work

Employee Health Requirements

Exposure/Sensory Requirements:

Exposure to:

• Chemicals: None 
• Video Display Terminals: Extreme 
• Blood and Body Fluids: None 
• TB or Airborne Pathogens: None. 

Sensory requirements (speech, vision, smell, hearing, touch): 

• Speech: Needed for presentations/training, telephone communication, facilitate meetings. 
• Vision: Needed to read memos and literature. 
• Smell: N/A 
• Hearing: Needed for telephone communications, meetings, and listening to employee concerns. 
• Touch: Need to write, do computer entry, filing. 

Activity/Lifting Requirements 

Percentage of time during the normal workday the employee is required to: 

• Sit: 85% 
• Twist: 0% 
• Stand: 5% 
• Crawl: 0% 
• Walk: 5% 
• Kneel: 0% 
• Lift: 2% 
• Drive: 0% 
• Squat: 1% 
• Climb: 0% 
• Bend: 1% 
• Reach above shoulders: 1% 

The weight required to be lifted each normal workday according to the continuum described below: 

• Up to 10 lbs: Occasionally 
• Up to 20 lbs: Occasionally 
• Up to 35 lbs: Not Required 
• Up to 50 lbs: Not Required 
• Up to 75 lbs: Not Required 
• Up to 100 lbs: Not Required 
• Over 100 lbs: Not Required 

Describe and explain the lifting and carrying requirements. (Example: the distance material is carried; how high material is lifted, etc.): Lifting is not usually required. 

Maximum consecutive time (minutes) during the normal workday for each activity: 

• Sit: 408 
• Twist: 0 
• Stand: 24 
• Crawl: 0 
• Walk: 24 
• Kneel:0 
• Lift: 9 
• Drive: 0 
• Squat: 8 
• Climb: 0 
• Bend: 8 
• Reach above shoulders: 4 

Repetitive use of hands (Frequency indicated): 

• Simple grasp up to 10 lbs. Normal weight: 5- 10# frequent 
• Pushing & pulling Normal weight: 
• Fine Manipulation: Terminal entry, calculator. 

Repetitive use of foot or feet in operating machine control: None 

Environmental Factors &Special Hazards 

• Environmental Factors (Time Spent): 
• Inside hours: 40 
• Outside hours : 0 
• Temperature: Normal Range
• Lighting: Average 
• Noise levels: Average 
• Humidity: Normal Range 
• Atmosphere: Dust &Poor Ventilation 

Special Hazards: None 

Protective Clothing Required: None