Denials Team Lead Professional Billing | Permanent WFH

BizForce is seeking a highly experienced, results-driven Denials Team Lead – Professional Billing to oversee a team of three Denials Specialists while actively managing complex, aged accounts receivable (AR) and driving revenue recovery for a U.S.-based healthcare organization.

This is a hands-on leadership role that combines direct claims resolution, team coaching, denial management, and strategic AR analysis. The ideal candidate has advanced expertise in Epic Resolute Professional Billing, a strong understanding of U.S. healthcare revenue cycle management (RCM), and a proven track record of recovering high-dollar balances from denied, underpaid, and outstanding claims.

Key Responsibilities

Claims Resolution & Revenue Recovery

• Manage and resolve assigned 90+ day professional billing AR accounts, including denied, underpaid, and outstanding claims.
• Handle complex, high-dollar, and escalated claims through investigation, correction, resubmission, appeals, and payer follow-up.
• Utilize Epic Resolute Professional Billing to manage work queues, claim edits, denial workflows, account documentation, and AR reporting.
• Analyze ERA/EOB information and CARC/RARC codes to identify and resolve denial causes related to eligibility, authorization, coding, medical necessity, modifiers, bundling, and credentialing.
• Ensure timely submission of corrected claims, reconsiderations, and appeals while protecting filing deadlines.
• Coordinate with internal departments to resolve claim discrepancies and maximize reimbursement.
  
  

Team Leadership & Quality Assurance

• Lead, mentor, and support a team of three Denials Specialists while maintaining individual claims production responsibilities.
• Assign and prioritize accounts based on outstanding balances, recovery potential, payer requirements, and aging.
• Conduct regular team huddles, provide technical guidance, and assist with complex payer escalations.
• Train team members on Epic workflows, denial resolution, appeals processing, and effective payer communication.
• Review team performance and audit claims for accuracy, documentation quality, and resolution effectiveness.
• Identify workflow inefficiencies and implement process improvements to strengthen collections performance.
• Collaborate with coding, credentialing, authorization, and other revenue cycle teams to address recurring denial trends.
  
  

AR Analysis, Reporting & Performance Management

• Analyze AR aging reports, denial trends, payer performance, and outstanding balances to identify high-value recovery opportunities.
• Monitor individual and team collections, claims worked, payment success rates, and unresolved AR balances.
• Track actual cash collections attributable to team efforts and distinguish collected revenue from pending claims and anticipated payments.
• Prepare weekly performance reports highlighting recovered revenue, major claim resolutions, outstanding opportunities, and operational challenges.
• Participate in Client Success meetings to discuss financial results, recovery strategies, and improvement opportunities.
• Recommend workload adjustments, training initiatives, and escalation strategies based on collection performance and AR trends.
  
  

Qualifications

• At least 4–5 years of experience in U.S. healthcare revenue cycle management, specializing in professional billing, aged AR follow-up, and complex denial resolution.
• At least 1–2 years of experience in a team lead, senior specialist, or supervisory role, with demonstrated hands-on claims management and coaching experience.
• Advanced hands-on experience with Epic Resolute Professional Billing is required, including work queues, claim edits, denial management, and AR reporting.
• Strong knowledge of professional billing claims, including CMS-1500 forms and 837P electronic transactions.
• Extensive experience resolving high-dollar, aged, denied, and underpaid claims.
• In-depth understanding of CPT, HCPCS, ICD-10-CM, CARC/RARC codes, NCCI edits, and billing modifiers.
• Proven experience handling Medicare, Medicaid, managed care, and commercial insurance payer denials and appeals.
• Strong analytical skills with the ability to interpret AR reports, identify denial patterns, and prioritize revenue recovery opportunities.
• Proficiency in Microsoft Excel, performance reporting, and collections tracking.
• Excellent English communication, problem-solving, decision-making, and remote team leadership skills.
• Strong understanding of HIPAA regulations, payer requirements, and healthcare billing compliance.
• Amenable to work during US hours
• Must be willing to undergo a background check as part of the hiring process.
  
  

Perks

• Permanent Work From Home
• Leave Credits
• Monetary Allowance
• Annual Bonus
• Weekly Paychecks
• Fixed Weekends Off
• Thriving Company Culture with Complete Autonomy
• Exclusive Specialized Training Programs
• Unlock Your Potential with a Highly Competitive Salary
  
  

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