Denials Team Lead – Professional Billing | Permanent WFH

BizForce; Metro Manila; Remote; PHP 1.200.000 - 1.800.000; Vollzeit

Benefits dieser Stelle

Permanent Work From Home

Leave Credits

Monetary Allowance

Annual Bonus

Weekly Paychecks

Fixed Weekends Off

Thriving Company Culture with Complete

Autonomy

Exclusive Specialized Training Program

Zusammenfassung

BizForce is seeking a highly experienced Denials Team Lead – Professional Billing to oversee a three-person team and drive recovery of aged AR for a U.S.-based healthcare client. This hands-on leadership role combines direct claims resolution, coaching, denial management, and strategic AR analysis.

The ideal candidate has advanced expertise with Epic Resolute Professional Billing, strong U.S. healthcare RCM knowledge, and a track record of recovering high-dollar balances from denied or underpaid

Qualifikationen

• 4–5 years of experience in U.S. healthcare revenue cycle management, specializing in professional billing, aged AR follow-up, and complex denial resolution.
• 1–2 years of team lead/supervisory experience with hands-on claims management and coaching.
• Advanced hands-on experience with Epic Resolute Professional Billing including work queues, denial management, AR reporting.
• Strong knowledge of CMS-1500 forms and 837P electronic transactions.
• Experience handling Medicare, Medicaid, managed care, and commercial payer denials and appeals.
• Strong analytical skills to interpret AR reports and identify denial patterns.
• Excellent English communication and remote team leadership skills.
• HIPAA regulations and payer requirements understanding.
• Willingness to work during US hours.

Aufgaben

• Manage and resolve 90+ day professional billing AR accounts.
• 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.
• Lead, mentor, and support a team of three Denials Specialists while maintaining production responsibilities.
• Train team members on Epic workflows, denial resolution, appeals processing, and payer communication.
• Review team performance and audit claims for accuracy 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.

Kenntnisse

Team leadership

AR analysis

Denial management

RCM knowledge

Payer communications

English communication

Tools

Epic Resolute Professional Billing

Microsoft Excel

CMS-1500/837P knowledge

Jobbeschreibung

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

Who are we?

BizForce is one of the fastest-growing global outsourcing companies in the world, founded in the US in Tucson, Arizona and is now operational in PH!

Our Commitment to delivering high-quality results for our clients and the only way to do that is ensuring a rewarding, respectful and productive experience for our employees. We hold the same values for both our customers and our employees.