AR Resolution Specialist Lead

The Cardiac & Vascular Institute•Gainesville, FL

3d•Onsite / Hybrid / Remote

About The Position

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.

Requirements

High School Diploma or equivalent required
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
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

Nice To Haves

Associate’s or Bachelor’s degree in Healthcare Administration, Business, or related field preferred

Responsibilities

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
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
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
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
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
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
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