Collections Specialist, Team Lead (Collections + Training)

Position Overview:

Reporting to the Hospital Collections Supervisor, the AR Team Lead supports the Accounts Receivable team by performing advanced insurance collections activities while providing peerto-peer guidance and training to new hires. This role combines Level II and Level III AR responsibilities, including resolution of complex and high-dollar claims, contract review, denial management, and escalation support. The AR Team Lead serves as a subject matter resource for the team, assisting with onboarding, workflow prioritization, and best practices to ensure timely claim resolution and accurate reimbursement across all payer types.

Responsibilities:

• Perform timely follow-up and resolution on outstanding A/R including unpaid, underpaid, or denied claims for all payer types including commercial, Medicare, Medicaid, and self-pay to maximize reimbursement.
• Serve as a resource for functional training of new hires, offering ongoing guidance on daily responsibilities, workflow execution, and process clarification.
• Partner with the Process Documentation Team to ensure documentation updates are approved and updated in a timely manner.
• Partner with QA Team to ensure quality and productivity metrics are reported and consistently met.
• Responsible for maintaining training materials and assisting with training content development based on QA results and team member education opportunities.
• Manage and prioritize daily work queues with a focus on high-dollar and complex claim balances.
• Investigate claim denials and underpayments, initiate appeals, and escalate issues when appropriate.
• Review payer contracts, fee schedules, and explanation of benefits (EOBs) to ensure claims have been processed accurately.
• Prepare and submit medical necessity appeals and supporting documentation when applicable.
• Review medical records and clinical documentation to determine medical necessity and support appeal submissions.
• Identify payer trends or reimbursement issues and communicate findings to leadership.
• Facilitate communication with insurance carriers, patients, and internal departments including billing, coding, and payment posting to resolve outstanding balances.
• Recommend account adjustments or refunds when overpayments or discrepancies are identified.
• Provide peer-to-peer onboarding support and mentorship for new AR collectors.
• Assist new hires in learning workflows, payer follow-up processes, and system navigation.
• Share best practices for denial resolution, appeal preparation, and claim follow-up.
• Serve as a subject matter resource for team members regarding payer policies, AR workflows, and claim resolution strategies.
• Assist leadership in addressing complex claim issues and identifying workflow improvement opportunities.

Required Skills:

• Strong analytical and problem-solving abilities related to claim resolution and denial management.
• Excellent written and verbal communication skills.
• Strong organizational and time management skills with the ability to prioritize competing tasks.
• Ability to interpret payer explanations of benefits and managed care contract language.
• Ability to work independently while managing multiple priorities.
• Strong collaboration and interpersonal communication skills.
• Intermediate computer proficiency in Microsoft Office including Excel and Outlook.

Required Experience:

• 5+ years of hospital or acute care AR / collections experience preferred.
• Strong knowledge of insurance billing, denial management, and accounts receivable processes.
• Experience working with commercial and government payers including Medicare, Medicaid, and Managed Medicare plans.
• Experience reviewing payer contracts and determining reimbursement accuracy.
• Experience working with healthcare billing systems and payer portals preferred (Waystar, Cerner, Meditech, CPSI, etc.).
• Demonstrated ability to mentor peers and support team development.
• High school diploma or equivalent required.