AR Follow-up and Denial Specialist

Aligned Orthopedic Partners•Virginia Beach, VA

About The Position

Aligned Orthopedic Partners is recruiting an experienced AR Follow-up and Denial Specialist. The ideal candidate is experienced with analyzing and resolving insurance claim denials, correcting errors, and securing accurate reimbursement from payers. This role requires strong analytical, coding, and communication skills, with a focus on denial prevention, timely appeals, and collaboration across the revenue cycle team.

Requirements

Minimum of 3 years’ experience in a medical billing department (orthopedic or surgical experience strongly preferred).
In-depth knowledge of healthcare billing, claims processing, payer follow-up, and appeals.
Proficiency with payer websites, Microsoft Outlook, Word, and Excel.
Coding knowledge sufficient to process denied claims and support appeals.
Strong reasoning, critical thinking, analytical, and mathematical skills.
Ability to work independently with high productivity and attention to detail.
High School Diploma or GED required.

Nice To Haves

CPC certification preferred but not required.

Responsibilities

Review denied and unpaid claims to verify coding and billing accuracy.
Correct errors and submit revised claims when necessary.
Investigate claims with no payer response to confirm receipt and follow up.
Analyze denials and generate effective, well-researched written appeals.
Appeal denials through coding review, contract interpretation, medical record review, and direct payer interaction.
Maintain detailed knowledge of payer websites and appeal processes for commercial and government payers.
Ensure appeals and reconsideration requests are completed accurately and on time.
Identify recurring denial trends or payer policy changes affecting reimbursement.
Communicate trends to management and recommend process improvements to prevent reoccurrence.
Support and participate in process and quality improvement initiatives.
Confer with coders, billing staff, and revenue cycle managers on coding or claim issues.
Provide education to team members on payer policies and denial prevention.
Collaborate on special projects and assist management with additional tasks as assigned.
Work assigned follow-up queues, including identification of missing payments, overpayments, and credits on accounts.
Document all actions taken in the practice management system.