Job Description

The Lead Accounts Receivable Claims Specialist is responsible for overseeing the daily operations of the Accounts Receivable Claims team while managing complex denial resolution activities. This position serves as the subject matter expert for claim denials, appeals, payer follow-up, and reimbursement issues. The Lead Accounts Receivable Claims Specialist provides guidance and support to team members, monitors department performance, identifies denial trends, and collaborates with providers, payers, and leadership to maximize reimbursement and improve revenue cycle performance.

Essential Functions

• Lead and coordinate the daily workflow of the Accounts Receivable Claims team.
• Serve as the primary resource for staff regarding denial resolution, appeals, and payer-specific requirements.
• Stay current on payer policies and coverage guidelines and communicate changes to team members.
• Monitor accounts receivable work queues to ensure timely identification and resolution of payment denials.
• Review and resolve complex claim denials, underpayments, and reimbursement discrepancies.
• Identify payment denials through work queues and take appropriate action to resolve them.
• Communicate professionally with providers when necessary to obtain documentation or clarification needed to resolve denied claims.
• Resubmit corrected claims based on payer policies or provider direction.
• Prepare and submit appeals with supporting documentation to ensure proper claim adjudication.
• Stay current on appeal processes and requirements for assigned payer groups.

Education and/or experience

• High school diploma or equivalent required; Associate degree in Healthcare Administration, Business, or a related field preferred.
• Minimum 4–5 years of experience in medical billing, accounts receivable, or denial management.
• Minimum 1–2 years of leadership, supervisory, mentoring, or team lead experience preferred.
• Strong knowledge of medical insurance plans including commercial, Medicare, Medicaid, and Tricare.
• Advanced understanding of claims adjudication, denial management, appeals, and reimbursement methodologies.
• Familiarity with medical terminology and CPT/ICD-10 codes.
• Experience with practice management systems and EHR platforms.
• Strong knowledge of medical coding concepts and third-party payer operations.
• Excellent communication and customer service skills.
• Strong analytical, problem-solving, and critical-thinking abilities.
• Familiarity with Microsoft applications, including but not limited to Word and Excel.
• Strong written and verbal communication skills, including the ability to confidently communicate with patients, providers, insurance representatives, and staff.
• Excellent organizational skills to manage multiple tasks, priorities, and deadlines.
• Demonstrated ability to work as a team player in a collaborative medical practice environment.
• Ability to communicate and work well with co-workers through open and honest communication.
• Ability to effectively communicate orally and in writing with internal and external business professionals.
• Must be responsible, reliable, and able to carry out job functions with minimal supervision.
• Demonstrated leadership skills with the ability to mentor staff and drive departmental performance improvements.

Total Rewards
The referenced base salary range represents the low and high end of Chesapeake Specialty Care salary range for this position.Some candidates will not be eligible for the upper end of the salary range. Exact salary will ultimately depend on multiple factors, which may include the successful candidate's geographic location, skills, work experience, market conditions, internal equity, responsibility factor and span of control, education/training and other qualifications.