Accounts Receivable (A/R) Specialist - Medical Billing

Optima Medical•Scottsdale, AZ

About The Position

Optima Medical is an Arizona-based medical group with 34 locations and more than 150 medical providers serving over 200,000 patients. Its mission is to improve quality of life in Arizona and Nevada through personalized healthcare, with a focus on preventing leading causes of death. Its services include cardiovascular and behavioral health, allergy testing and immunotherapy, in-house lab testing, imaging, chronic disease management, and other specialty health services. The A/R Specialist manages accounts receivable, reviews and corrects denied or rejected claims, and follows up with insurance carriers to support timely reimbursement. The position requires knowledge of healthcare payer guidelines, claim workflows, and primary care billing practices. The specialist works claims through final resolution, maintains accurate claim documentation, manages aging balances, and identifies denial trends and issues for escalation or prevention.

Requirements

Three to five years of experience in medical billing, denials management, and A/R follow-up.
Demonstrated experience independently researching and resolving complex denials, appeals, and payer escalations.
Experience managing aging accounts receivable, including claims aged 90 days or more and 120 days or more.
Strong understanding of EOBs, ERAs, payer rules, denial-resolution strategies, and revenue-cycle processes.
Experience with claim-management and EHR systems.
Excellent communication, organization, analytical, and problem-solving skills.

Nice To Haves

Primary care (PCP) billing experience.
Experience with eClinicalWorks (eCW).
Experience handling complex A/R accounts and denials.

Responsibilities

Follow up on insurance claims to support timely and accurate payment.
Review, research, correct, and resubmit denied or rejected claims as needed.
Communicate with insurance carriers to resolve claim issues and discrepancies.
Work claims through final resolution to obtain appropriate reimbursement or adjustment.
Independently research and resolve complex denials, including medical-necessity and coding-related denials, appeals, and payer escalations.
Identify payer trends and provide feedback to management.
Identify recurring denial patterns and recommend opportunities to prevent future denials.
Use insurance portals to verify claim status, eligibility, and payer notes.
Maintain accurate, detailed documentation of claim activity, denials, appeals, and adjustments.
Identify and escalate credentialing or contracting issues.
Maintain an organized follow-up queue with accurate claim status and next actions.
Review and resolve daily remit-code denials according to payer and company guidelines, including bundled or non-covered services, lack of medical necessity, eligibility or demographic issues, out-of-network or credentialing issues, and modifier, place-of-service, or CLIA-number issues.
Aggressively work aging A/R balances, including claims over 90 and 120 days, toward resolution and payment.
Analyze recurring denial trends and collaborate with internal teams to identify root causes and reduce repeat denials.