Working as a hands-on team resource, the Team Lead monitors recovery inventories, assigns and prioritizes work, manages escalations and high-priority cases, coaches Recovery Specialists, and identifies systemic reimbursement barriers. The position partners across Revenue Integrity, Billing, Order Management, Finance, and operational teams to accelerate cash, strengthen appeal outcomes, reduce revenue leakage, and improve sustainable recovery performance.
Core Competencies- Frontline Leadership & Coaching - Provides daily work direction, coaching, mentoring, and accountability while supporting team development.
- Revenue Recovery Strategy - Applies reimbursement and recovery expertise to prioritize denial, appeal, underpayment, and aged-account opportunities.
- Appeals Management - Guides effective appeal development, escalation, follow-up, and payer-response strategies.
- Financial Analysis - Evaluates recovery dollars, aging, payer trends, underpayments, and financial impact to focus team effort.
- Problem Resolution - Removes barriers, manages complex cases, and escalates systemic reimbursement issues appropriately.
- Revenue Protection - Identifies patterns contributing to leakage and supports corrective actions that preserve reimbursement.
- Critical Thinking & Problem Solving - Uses root-cause analysis and sound judgment to improve recovery outcomes and reduce recurrence.
- Cross-Functional Collaboration - Partners effectively across Revenue Integrity, Billing, Order Management, Finance, and operational teams.
Essential Duties & Responsibilities Operational Leadership
- Monitor denial, appeal, underpayment, recovery, and aged-account inventories and associated work queues.
- Assign and prioritize work based on aging, financial impact, payer requirements, recovery potential, and operational urgency.
- Manage escalations, high-priority cases, and complex reimbursement issues requiring advanced review.
- Serve as the first point of escalation and subject matter resource for assigned Recovery Specialists.
- Escalate systemic payer, reimbursement, compliance, or operational barriers to management.
Recovery Optimization & Appeals
- Drive recovery outcomes across Commercial, Workers' Compensation, and Personal Injury payer categories.
- Monitor appeal success rates, denial overturn performance, underpayment recovery, and payer responsiveness.
- Guide team strategy for denied, underpaid, aged, or otherwise unresolved accounts.
- Identify systemic barriers to reimbursement and recommend targeted resolution strategies.
- Support effective payer escalation and follow-up approaches to accelerate reimbursement.
Staff Leadership & Development
- Coach, mentor, and provide day-to-day work direction to assigned Recovery Specialists.
- Monitor individual and team productivity, quality, aging, and recovery performance.
- Support onboarding, training, cross-training, and ongoing competency development.
- Provide timely performance feedback and escalate recurring performance concerns to management.
- Promote accountability, collaboration, and consistent execution of recovery standards.
Revenue Protection & Operational Improvement
- Identify trends contributing to denials, underpayments, aged receivables, revenue leakage, or delayed cash.
- Support corrective actions and workflow improvements that strengthen reimbursement performance.
- Partner with operational departments to address root causes and reduce preventable denial recurrence.
- Provide recovery insights and trend information to support management reporting and prioritization.
- Participate in continuous-improvement initiatives related to appeals, recovery, account resolution, and payer performance.
Success in this role will be measured against the following Key Performance Indicators (KPIs) once performance benchmarks and baseline expectations have been established Experience & Education - Associate degree required; Bachelor's degree preferred.
- Five (5)+ years of healthcare reimbursement, denial management, appeals, collections, or revenue recovery experience.
- Leadership, supervisory, coordinator, or team lead experience preferred.
- Working knowledge of DME/HME reimbursement and Commercial, Medicare, Workers' Compensation, and Personal Injury reimbursement and recovery processes.
- Strong understanding of denial resolution, appeals, underpayment recovery, aged accounts, payer follow-up, and reimbursement methodologies.
- Experience analyzing recovery inventories, payer trends, aging, productivity, and financial outcomes.
- Strong written and verbal communication skills with the ability to coach, prioritize, influence, and escalate effectively.
- Strong analytical, financial, organizational, and problem-solving skills with exceptional attention to detail.
- Experience with revenue cycle systems, payer portals, reporting tools, and Microsoft Office preferred.
