A/R Denials Specialist.
About The Position
About Optima Optima Medical is an Arizona-based medical group consisting of 30 locations and over 130+ medical providers, who care for more than 200,000 patients statewide. Our mission is to improve the quality of life throughout Arizona by helping communities "Live Better, Live Longer" through personalized healthcare, with a focus on preventing the nation’s top leading causes of death. We go beyond primary care with a full spectrum of services including cardiovascular health services, behavioral health, allergy testing and immunotherapy, in-house lab testing, imaging, chronic disease management, and other specialty health services. We aspire to aid the growth of our company by welcoming the most qualified and deserving candidates aboard. The ideal candidate will have experience in a fast-paced healthcare or billing environment, with strong attention to detail and a passion for resolving claims efficiently to ensure a positive patient and provider experience. Position Summary: The Medical Billing Denials Specialist is responsible for managing accounts receivable (A/R), reviewing and correcting denied or rejected claims, and ensuring timely follow-up with insurance carriers. This role requires strong knowledge of healthcare payer guidelines, claim workflows, and primary care billing practices.
Requirements
- Minimum 2–3 years of experience in medical billing, denials, and A/R follow-up.
- Strong understanding of EOBs, ERAs, payer rules, and revenue cycle processes.
- Experience working with claim management and EHR systems.
- Excellent communication, organization, and problem-solving skills.
Nice To Haves
- Primary Care (PCP) billing experience preferred.
Responsibilities
- Follow up on insurance claims to ensure timely and accurate payment.
- Review, research, and correct denied or rejected claims; resubmit as necessary.
- Communicate with insurance carriers to resolve claim issues and discrepancies.
- Identify payer trends and provide feedback to management.
- Navigate insurance portals to verify claim status, eligibility, and payer notes
- Maintain accurate and detailed documentation of all claim activity, denials, appeals & adjustments.
- Identify and escalate credentialing or contracting issues
- Maintain an organized follow-up bucket with accurate claim status and next actions.
- Review and resolve daily denials assigned by remit code per payer and company guidelines, including:
- Bundled or Non-Covered Services
- Lack of Medical Necessity
- Insurance Eligibility / Demographic Issues
- Out-of-Network / Credentialing
- Modifiers, POS, CLIA #
Stand Out From the Crowd
Upload your resume and get instant feedback on how well it matches this job.
What This Job Offers
Job Type
Full-time
Career Level
Entry Level
Education Level
No Education Listed
