Accounts Receivable Lead - Medical Billing

Yosemite Pathology Medical Group•Modesto, CA

2d•Onsite

About The Position

The Accounts Receivable (AR) Lead plays a critical role in optimizing billing operations and implementing revenue cycle best practices in response to payer adjudication across contracted, non-contracted, and government payer groups. This position is responsible for overseeing claims processing and accounts receivable activities, with a strong focus on resolving low-pay claims, denials, expected reimbursement discrepancies, and appeals. The AR Lead ensures accurate billing, timely reimbursement, and compliance with all regulatory and payer requirements, while also supporting team performance, identifying trends, and driving process improvements to enhance overall revenue cycle efficiency.

Requirements

Minimum of 5 years of medical billing experience, including strong Accounts Receivable and denial management experience (pathology billing experience strongly preferred)
Proven experience in a lead or senior-level role, with the ability to coach, train, and support team members
Advanced knowledge of PPO, HMO, IPA, CMS, Managed Medicaid, and Managed Medicare plans, including payer-specific billing requirements
Strong working knowledge of CPT and ICD coding, with the ability to interpret and apply coding in denial resolution
Demonstrated expertise in denial management, appeals processes, and root cause analysis
Strong understanding of insurance eligibility, benefits, and front-end impacts on AR outcomes
Ability to analyze AR aging reports, identify trends, and implement process improvements
Experience auditing work for accuracy, compliance, and quality assurance
Proficiency in payor portal utilization and navigating multiple systems to resolve claims
Strong knowledge of timely filing limits and reimbursement guidelines across payers
Excellent written and verbal communication skills, with the ability to effectively interact with patients, payers, and internal stakeholders
Strong documentation, research, and problem-solving skills with attention to detail
Ability to manage high-volume workloads while maintaining accuracy and meeting deadlines
Highly organized, self-motivated, and able to prioritize and reprioritize tasks in a fast-paced environment
Ability to collaborate effectively across departments and serve as a key resource for issue resolution

Nice To Haves

pathology billing experience

Responsibilities

Lead and oversee daily Accounts Receivable (AR) workflows, ensuring timely follow-up and resolution of outstanding claims
Serve as a subject matter expert for pathology billing, providing guidance on complex denials, coding nuances, and payer-specific requirements
Monitor team productivity and quality metrics; provide coaching, feedback, and support to ensure KPI targets are met
Review and prioritize high-value, aged, and complex AR accounts for resolution
Identify denial trends and root causes specific to pathology services; develop and implement corrective action plans
Collaborate with coding, front-end, and client services teams to resolve billing discrepancies and improve clean claim rates
Act as a point of escalation for unresolved claims, payer issues, and client concerns
Ensure timely filing limits are met and minimize avoidable write-offs
Audit team work for accuracy, compliance, and adherence to internal policies and procedures
Provide training and onboarding support for new team members; assist in developing training materials and standard operating procedures
Maintain and update payer-specific billing guidelines, including pathology-related rules and reimbursement policies
Partner with management to develop workflow improvements, automation opportunities, and process efficiencies
Generate and analyze AR reports, including aging, denial rates, and reimbursement trends; present findings and recommendations to leadership
Support month-end close processes, including reconciliation and reporting activities
Ensure compliance with all regulatory requirements, including HIPAA and payer guidelines